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Shastidy Pauline Madrid, CCSS
Military Health Care Provider in Tijeras, New Mexico
NPI 1962273854

Shastidy Pauline Madrid is a Military Health Care Provider based in Rio Rancho, NM. Shastidy Pauline Madrid practices in Tijeras, NM and has the professional credentials of CCSS. The NPI Number for Shastidy Pauline Madrid is 1962273854 and holds a License No. (New Mexico).

The current practice location address for Shastidy Pauline Madrid is 1 Camino Oro Ct, Tijeras, NM and can be reached out via phone at 706-593-8731 and via fax at 706-593-8732.

Location: 1 Camino Oro Ct, Tijeras, NM, 87174-5681
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1962273854
Provider Name
Shastidy Pauline Madrid
Credential
CCSS
Provider Entity Type
Individual
Gender
Female
Address
1 Camino Oro Ct, Tijeras, NM, 87174-5681
Phone Number
706-593-8731
Fax Number
706-593-8732
Provider Enumeration Date
01/10/2024
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
1 Camino Oro Ct
City
Tijeras
State
New Mexico
Zip
87059-7924
Phone Number
706-593-8731
Fax Number
706-593-8732
person
Provider Business Mailing Address Details
Address
1 Camino Oro Ct
City
Tijeras
State
New Mexico
Zip
87059-7924
Phone Number
706-593-8731
Fax Number
706-593-8732
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Military Health Care Provider
Speciality
-
Taxonomy
171000000X
License No.
()
Definition
Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes.
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