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Individual

ROSALIND MONICA DEGEORGE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
111 SANDOVAL RD SW, LOS LUNAS, NM 87031-7320
(505) 565-4355
(505) 565-4360
Mailing address
111 SANDOVAL RD SW, LOS LUNAS, NM 87031-7320
(505) 565-4355
(505) 565-4360

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2005-0054
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
202010875
PRESBYTERIAN HEALTH PLAN
NM
05
49050231
NM
01
P00340493
RAILROAD MEDICARE
NM
Enumeration date
08/04/2006
Last updated
09/28/2007
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