Individual
VINCENT PAUL BACA SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPSW
Contact information
Practice address
9201 MONTGOMERY BLVD NE # 5, ALBUQUERQUE, NM 87111-2468
(505) 217-1717
(505) 213-0041
Mailing address
9201 MONTGOMERY BLVD NE # 5, ALBUQUERQUE, NM 87111-2468
(505) 217-1717
(505) 213-0041
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
979
NM
175T00000X
Peer Specialist
—
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
979
CERTIFICATION
NM
Enumeration date
02/26/2021
Last updated
02/26/2021
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