Individual
CARMELITA AGODON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1901 REDROCK DR, REHOBOTH MCKINLEY CHRISTIAN HEALTH CARE SERVICES, GALLUP, NM 87301-5683
(505) 863-7120
Mailing address
1901 REDROCK DR, PFS DEPT, GALLUP, NM 87301-5683
(505) 863-7000
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
2001-01
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10004799
LOVELACE HEALTH/SALUD
NM
05
—
48126705
—
NM
01
—
768781
AHCCCS
AZ
01
—
85031326887301A159
CHAMPUS
—
01
—
NM009E83
BC/BS
NM
01
—
P00200853
RAILROAD MEDICARE
—
01
—
P00211389
RAILROAD MEDICARE
—
01
—
PROVP11034
MOLINA
NM
Enumeration date
01/05/2006
Last updated
07/08/2007
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