Individual
SHILOH DAWN MANGINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2504 CAMINO ENTRADA, SANTA FE, NM 87507-4851
(505) 471-5006
Mailing address
15 OAK ST, CLAYTON, NM 88415-2530
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
06/06/2012
Last updated
06/06/2012
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