Organization
CANYON LIGHT INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN P BALDONADO L.A.D.A.C. (OWNER/PRESIDENT)
(575) 430-6913
Entity
Organization
Contact information
Practice address
1301 CUBA AVE, ALAMOGORDO, NM 88310-5727
(575) 437-2453
(575) 443-1504
Mailing address
PO BOX 114, ALAMOGORDO, NM 88311-0114
(575) 437-2453
(575) 443-1504
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
NM
Other
Enumeration date
10/05/2010
Last updated
10/05/2010
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