Most Relevant Information
Provider Data
| NPI Number: | 1003248931 |
| Provider Name: | TIA M ROES PA-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/02/2013 |
| Last Updated: | 08/02/2013 |
Provider Practice Location
145 DON PASQUAL NW
LOS LUNAS
NM
87031
Practice Location Phone/Fax
| Phone: | 5058654618 |
| Fax: | 5052248727 |
Provider Mailing Location
116 ARROYO DR
SOCORRO
NM
878014403
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |