Individual
SEVERO BACA III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5600 GIBSON BLVD SE APT 144, ALBUQUERQUE, NM 87108-5391
(505) 404-8133
Mailing address
5600 GIBSON BLVD SE APT 144, ALBUQUERQUE, NM 87108-5391
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
06/01/2020
Last updated
06/01/2020
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