Individual
MARIA CRISOSTOMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1039 PAISANO RD, SANTA ROSA, NM 88435-3757
(575) 512-9769
Mailing address
1039 PAISANO RD, SANTA ROSA, NM 88435-3757
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SAH-2024-0375
NM
Other
Enumeration date
09/03/2021
Last updated
09/26/2024
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