Individual
JACKIE BOCANEGRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8500 LLANO VISTA AVE SW, ALBUQUERQUE, NM 87121-7046
(505) 339-9355
Mailing address
8500 LLANO VISTA AVE SW, ALBUQUERQUE, NM 87121-7046
(505) 339-9355
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
517085936
NM
Other
Enumeration date
12/11/2024
Last updated
12/11/2024
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