Individual
KARISSA RYANN VASQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
200 EMILIO LOPEZ RD, LOS LUNAS, NM 87031
(505) 866-2700
(505) 866-2701
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
LL52602
SC
207Q00000X
Family Medicine Physician
Primary
MD2021-0956
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
59220759
—
NM
Enumeration date
04/24/2018
Last updated
05/16/2023
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