Provider Demographics
NPI:1003248931
Name:ROES, TIA M (PA-C)
Entity Type:Individual
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First Name:TIA
Middle Name:M
Last Name:ROES
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:116 ARROYO DR
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:NM
Mailing Address - Zip Code:87801-4403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:145 DON PASQUAL NW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031
Practice Address - Country:US
Practice Address - Phone:505-865-4618
Practice Address - Fax:505-224-8727
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant