Individual
MR. RANDY R MAXSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
23 ROAD 5507, BLOOMFIELD, NM 87413-9313
(707) 900-8073
(707) 812-6124
Mailing address
23 ROAD 5507, BLOOMFIELD, NM 87413-9313
(707) 900-8073
(707) 812-6124
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/31/2018
Last updated
05/31/2018
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