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General NPI Number Information
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NPI Number | 1689221921
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Entity Type | Individual
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Provider Name | DYLAN LEWIS GARNER
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Gender | Male
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Dates
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Enumeration Date | 08/21/2019
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Last Update Date | 08/21/2019
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Provider Practice Location Address
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Address Line | 91 ENTRADA ARAGON RD
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City | LOS LUNAS
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State | NM
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Zip | 87031-7629
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Country | US
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Telephone | 505-514-5327
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Fax |
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Provider Business Mailing Address
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Address Line | 823 P.O. BOX
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City | PERALTA
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State | NM
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Zip | 87042
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Country | US
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Telephone | 505-514-5327
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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