Individual
MRS. KRESTA S ANTILLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
145 DON PASQUAL RD NW, LOS LUNAS, NM 87031-8841
(505) 865-4618
(505) 224-8727
Mailing address
MSC 09 5040, 1 UNIVERSITY OF NEW MEXICO, ALBUQUERQUE, NM 87131-0001
(505) 994-5300
(505) 344-1233
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD2018-0733
NM
Other
Enumeration date
04/02/2015
Last updated
04/26/2022
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