Individual
NICOLE BACA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPSW
Contact information
Practice address
320 OSUNA RD NE STE H4, ALBUQUERQUE, NM 87107-5955
(505) 345-2778
Mailing address
320 OSUNA RD NE STE H4, ALBUQUERQUE, NM 87107-5955
(505) 345-2778
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
1142
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1142
CPSW NUMBER
NM
Enumeration date
06/16/2021
Last updated
06/16/2021
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