Individual
JONATHAN VILASIER IRALU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
516 E. NIZHONI BLVD., BOX 1337, GALLUP, NM 87301-1337
(505) 722-1000
(505) 726-8557
Mailing address
516 E. NIZHONI BLVD., BOX 1337, GALLUP, NM 87301-1337
(505) 722-1000
(505) 726-8557
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
95-259
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000R8847
—
NM
05
—
419631
—
AZ
Enumeration date
07/02/2006
Last updated
04/11/2008
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