Individual
DOREEN MARIE SIRACUSANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C/ MA
Contact information
Practice address
1501 SAN PEDRO DR SE, ALBUQUERQUE, NM 87108-5153
(505) 265-1711
(505) 256-2819
Mailing address
1501 SAN PEDRO DR SE, ALBUQUERQUE, NM 87108-5153
(505) 265-1711
(505) 256-2819
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
85PA013
NM
Other
Enumeration date
08/09/2006
Last updated
07/08/2007
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