NPI 1881020089

Jicarilla Apache Nation

Organisation End-Stage Renal Disease (ESRD) Treatment Clinic/Center Dulce, NM

Practice location

Address: 450 N Mundo Dr., Dulce, NM 87528
Phone: (575) 759-4206
Fax: (575) 759-4471

Authorised official

Name: Ty Vicenti
Title: President
Phone: (575) 759-4201

Registered specialties

End-Stage Renal Disease (ESRD) Treatment Clinic/Center Primary

Ambulatory Health Care Facilities Taxonomy 261QE0700X

Other Clinic/Center providers in New Mexico →

Registry record

NPI: 1881020089
Entity type: Organization
NPI issued: 19 Sep 2013
Record last updated: 20 May 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.