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Organization

VISTA EMERGENCY PHYSICIANS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KATHY KONDAS (OFFICER)
(973) 251-1132
Entity
Organization

Contact information

Practice address
1016 E ROOSEVELT AVE, GRANTS, NM 87020-2118
(973) 251-1132
(505) 287-5268
Mailing address
815 S PALAFOX ST, 3RD FLR, PENSACOLA, FL 32502-5937

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
28477073
NM
Enumeration date
08/30/2006
Last updated
12/05/2019
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