Individual
JEREMY CRUZ PUENTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
106 BLANCA AVE STE 300, ALAMOSA, CO 81101-2340
(719) 589-3658
(719) 589-0997
Mailing address
128 MARKET ST, ALAMOSA, CO 81101-2290
(719) 587-1001
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0019725
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19725
STATE LICENSE
CO
Enumeration date
07/19/2022
Last updated
07/19/2022
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