Organization
NORTHWEST REIONAL EDUCATION COOP #2
Active
Other names
Dulce School Based Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY MIZELL PHDC. (DIRECTOR)
(575) 756-1274
Entity
Organization
Contact information
Practice address
91 HAWK DRIVE, DULCE, NM 87528
(575) 759-2909
(575) 759-3533
Mailing address
PO BOX 113, CHAMA, NM 87520-0113
(575) 756-1274
(575) 756-1278
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
02314459009
NM
390200000X
Student in an Organized Health Care Education/Training Program
02314459009
NM
Other
Enumeration date
10/17/2012
Last updated
02/08/2013
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