Individual
CECILIA PINON PROVENCIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Contact information
Practice address
2070 W OHARA RD, ANTHONY, NM 88021-8844
(915) 873-1781
Mailing address
2070 W OHARA RD, ANTHONY, NM 88021-8844
(915) 873-1781
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
G-1598
NM
Other
Enumeration date
06/03/2025
Last updated
06/03/2025
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