Individual
MARCY Y MIRELES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5312 RIO BRAVO DR STE 10, SANTA TERESA, NM 88008-9210
(575) 915-1338
(575) 915-1819
Mailing address
5312 RIO BRAVO DR STE 10, SANTA TERESA, NM 88008-9210
(575) 915-1338
(575) 915-1819
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41425260
—
NM
05
—
PENDING
—
NM
Enumeration date
01/24/2020
Last updated
05/02/2023
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