Individual
SHAIA D'OURSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1302 CALLE DE LA MERCED, ESPANOLA, NM 87532-2624
(505) 747-0081
Mailing address
PO BOX 28220, SANTA FE, NM 87592-8220
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
M-08145
NM
Other
Enumeration date
11/15/2012
Last updated
11/15/2012
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