Individual
MR. MICHAEL ELLIS DEIERHOI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPSW
Contact information
Practice address
622 MANZANO ST NE, ALBUQUERQUE, NM 87110-6302
(505) 506-5261
(505) 925-4055
Mailing address
622 MANZANO ST NE, ALBUQUERQUE, NM 87110-6302
(505) 506-5261
(505) 925-4055
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
NM
Other
Enumeration date
06/04/2010
Last updated
03/20/2014
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