Individual
CORNELIUS R MACKEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4706 LEON GRANDE AVE SE, RIO RANCHO, NM 87124-1303
(505) 934-4431
Mailing address
202 11TH AVE NW, RIO RANCHO, NM 87144-4164
(505) 934-4431
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
376J00000X
Homemaker
—
—
Other
Enumeration date
08/03/2022
Last updated
08/05/2022
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