Individual
MISS BRECK PENROD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1320 S SOLANO DR, LAS CRUCES, NM 88001-3758
(575) 556-1669
Mailing address
2190 MARS AVE # 20, LAS CRUCES, NM 88012-8532
(505) 227-4203
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/15/2010
Last updated
10/15/2010
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