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Individual

STEPHEN BRANCH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
816 LA LUZ DR, BELEN, NM 87002-3343
(505) 450-3920
Mailing address
816 LA LUZ DR, BELEN, NM 87002-3343
(505) 450-3920

Taxonomy

Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary

Other

Enumeration date
02/03/2012
Last updated
02/03/2012
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