Organization
INDIGO DIAGNOSTICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIANA ULIBARRI HORAN M.D. PH.D NCED (PSYCHO EDUCATIONAL DIAGNOSTICIAN)
(505) 699-5315
Entity
Organization
Contact information
Practice address
HC 75 BOX 1198, RUTHERON, NM 87551-9725
(505) 699-5315
(575) 588-0199
Mailing address
HC 75 BOX 1198, RUTHERON, NM 87551-9725
(505) 699-5315
(575) 588-0199
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
350792
NM
103TM1800X
Intellectual & Developmental Disabilities Psychologist
350792
NM
251300000X
Local Education Agency (LEA)
350792
NM
251B00000X
Case Management Agency
350792
NM
251C00000X
Developmentally Disabled Services Day Training Agency
350792
NM
252Y00000X
Early Intervention Provider Agency
350792
NM
Other
Enumeration date
07/27/2016
Last updated
07/27/2016
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