Individual
CLEVEN ISIDOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
454 CORONADO ST NE, LOS LUNAS, NM 87031-8709
(505) 866-0456
Mailing address
1331 PONDEROSA AVE NW, ALBUQUERQUE, NM 87107-3357
(845) 553-4207
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
RN-83283
NM
Other
Enumeration date
02/20/2019
Last updated
02/20/2019
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