Jicarilla Apache Nation
NPI #1508051061 in Dulce, New Mexico
Provider Information
- NPI Number
- 1508051061
- Entity Type
- Organization
- Organization Name
- Jicarilla Apache Nation
- Primary Specialty
- Community/Behavioral Health
- Enumeration Date
- Sep 7, 2007
- Last Updated
- Sep 7, 2007
Practice Location
- Address
- 109 SENECA DRIVE
- City
- Dulce
- State
- New Mexico
- ZIP Code
- 87528
- Phone
- (505) 759-3162
Authorized Official
- Name
- MR. LEVI PESATA
- Title
- PRESIDENT
- Phone
- (505) 759-3242
Specialties & Taxonomy Codes
| Specialty |
|---|
| Community/Behavioral Health |
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