Individual
JENNIFER BOC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2074 GALISTEO ST, UNIT A-2, SANTA FE, NM 87505-2138
(505) 989-7418
Mailing address
1133 LOPEZ ST, SANTA FE, NM 87501-2486
(505) 699-8055
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
4652
NM
Other
Enumeration date
01/09/2009
Last updated
01/09/2009
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