Individual
ISABELO SAMSON SICSIC JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2450 S TELSHOR BLVD, LAS CRUCES, NM 88011-5069
(575) 521-5370
Mailing address
2450 S TELSHOR BLVD, LAS CRUCES, NM 88011-5069
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
RS2024-0042
NM
Other
Enumeration date
04/08/2024
Last updated
07/23/2024
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