Individual
KYLE MCKENZIE MANUELITO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6000 UPTOWN BLVD NE STE 140, ALBUQUERQUE, NM 87110-4157
(505) 305-4949
Mailing address
PO BOX 644, GALLUP, NM 87305-0644
(505) 713-4456
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
1570
NM
Other
Enumeration date
04/23/2024
Last updated
04/23/2024
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