Individual
MELISSA MONDRAGON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
224 CRUZ ALTA RD STE J, TAOS, NM 87571-5947
(575) 737-5533
(575) 737-5534
Mailing address
224 CRUZ ALTA RD STE J, TAOS, NM 87571-5947
(575) 737-5533
(575) 737-5534
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
83774556
—
NM
Enumeration date
12/09/2019
Last updated
12/09/2019
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