Individual
LAURA GUEREQUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4217 BIG SKY RD, SANTA FE, NM 87507-4845
(505) 469-8887
Mailing address
4217 BIG SKY RD, SANTA FE, NM 87507-4845
(505) 469-8887
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3618121567
—
NM
Enumeration date
02/04/2019
Last updated
02/04/2019
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