Individual
CHE MONDRAGON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
105 BERTHA RD STE B, TAOS, NM 87571-7148
(575) 758-4297
Mailing address
PO BOX 1741, RANCHOS DE TAOS, NM 87557-1741
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
08/16/2022
Last updated
02/13/2023
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