Individual
ILDA DEBORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
6352 FLOR DE MAYO PL NW, ALBUQUERQUE, NM 87120-2114
(505) 514-7110
(505) 898-9748
Mailing address
6352 FLOR DE MAYO PL NW, ALBUQUERQUE, NM 87120-2114
(505) 514-7110
(505) 898-9748
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
4079
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OORE78
BXBS
NM
Enumeration date
08/01/2006
Last updated
07/22/2009
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