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Individual

MARY SIANEZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1612 BONFORTE BLVD, PUEBLO, CO 81001-1603
(719) 543-3600
Mailing address
21 DUNDEE LN, PUEBLO, CO 81001-1727

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
86379755
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
86379755
CO
Enumeration date
11/05/2015
Last updated
11/05/2015
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