Organization
NEW MEXICO MOUNTAIN HEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK G DUMAL PHD (CEO)
(505) 404-6048
Entity
Organization
Contact information
Practice address
348 ST. RD. 4, SAN YSIDRO, NM 87053
(505) 404-6048
Mailing address
348 ST. RD. 4, SAN YSIDRO, NM 87053
(505) 404-6048
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
97-229
NM
Other
Enumeration date
07/29/2008
Last updated
07/30/2008
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