Individual
MRS. JEANETTE LOUISE JAQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3180 N BUTLER AVE STE 300, FARMINGTON, NM 87401-2336
(505) 320-4153
Mailing address
3180 N BUTLER AVE STE 300, FARMINGTON, NM 87401-2336
(505) 320-4153
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A-0418
NM
Other
Enumeration date
03/18/2010
Last updated
03/18/2010
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