Jicarilla Apache Nation

NPI #1881020089 in Dulce, New Mexico

Provider Information

NPI Number: 1881020089
Entity Type: Organization
Organization Name: Jicarilla Apache Nation
Primary Specialty: Clinic/Center - End-Stage Renal Disease (ESRD) Treatment
Enumeration Date: Sep 19, 2013
Last Updated: May 20, 2015

Practice Location

Address: 450 N MUNDO DR.
City: Dulce
State: New Mexico
ZIP Code: 87528
Phone: (575) 759-4206

Authorized Official

Name: TY VICENTI
Title: PRESIDENT
Phone: (575) 759-4201

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - End-Stage Renal Disease (ESRD) Treatment — End-Stage Renal Disease (ESRD) Treatment	261QE0700X	Primary

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