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General NPI Number Information
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NPI Number | 1366397010
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Entity Type | Organization
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Legal Business Name | SOL MESA MEDICAL GROUP LLC
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Dates
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Enumeration Date | 02/27/2026
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Last Update Date | 02/27/2026
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Provider Practice Location Address
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Address Line | 520 NM-564
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City | GALLUP
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State | NM
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Zip | 87301
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Country | US
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Telephone | 505-522-3681
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Fax | 505-473-9552
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Provider Business Mailing Address
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Address Line | 2418 E HISTORIC HIGHWAY 66 # 292
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City | GALLUP
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State | NM
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Zip | 87301-4767
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Country | US
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Telephone | 505-522-3681
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Fax | 505-473-9552
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Authorized Official
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Title or Position | CO-OWNER
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Name | MR. JOSEPH LEE ELIASON
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Credential | CNP
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Telephone | 505-906-6581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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