Individual
MR. JOHN GERARD LILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
LOBO CANYON RD, WESTERN NEW MEXICO CORRECTIONS, GRANTS, NM 87020-0250
(505) 876-8360
(505) 876-8357
Mailing address
PO BOX 250, GRANTS, NM 87020-0250
(505) 876-8360
(505) 876-8357
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
94PA31
NM
Other
Enumeration date
09/25/2007
Last updated
09/25/2007
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