Individual
MR. LOWELL MONTANA BENCOMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
2404 S LOCUST ST STE 5, LAS CRUCES, NM 88001-5789
(575) 521-4188
Mailing address
2404 S LOCUST ST STE 5, LAS CRUCES, NM 88001-5789
(575) 521-4188
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
697
NM
Other
Enumeration date
01/19/2015
Last updated
03/06/2017
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