Individual
MS. MARIE TALLENT DELOACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MT(ASCP)
Contact information
Practice address
500 NORTH MUNDO, DULCE, NM 87528
(575) 759-7252
(575) 759-3532
Mailing address
PO BOX 187, 500 NORTH MUNDO, DULCE, NM 87528-0187
(575) 759-7252
(575) 759-3532
Taxonomy
Speciality
Code
Description
License number
State
246QM0706X
Medical Technologist
Primary
03671395
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000K3526
—
NM
01
—
HSZ196
MEDICARE PART B
NM
Enumeration date
02/06/2012
Last updated
02/06/2012
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