Provider Information for 1770736134
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TANGELA ZOE ISELY M.C.L.M.H.C
Sex: Female
NPI: 1770736134
Last Updated: 2010-07-09
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1770736134 | ||||||||||||
| Enumeration Date | 2008-10-29 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | PO BOX 1349 SILVER CITY, NM 88062 United States Phone: 575-388-4497 | Fax:575-534-1150 | ||||||||||||
| Primary Practice Address | 315 S. HUDSON SILVER CITY, NM 88061 United States Phone: 575-388-4497 | Fax:575-534-1150 | ||||||||||||
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