Organization
SAN JUAN SURGICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMY M ROBISON (OWNER)
(505) 327-9694
Entity
Organization
Contact information
Practice address
622 W MAPLE ST STE C, FARMINGTON, NM 87401-6589
(505) 327-9694
Mailing address
622 W MAPLE ST STE C, FARMINGTON, NM 87401-6589
(505) 327-9694
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
—
NM
208600000X
Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Enumeration date
10/19/2010
Last updated
10/19/2010
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