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Individual

JANICE ALTA JUAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
100 DEPUTY DEAN MIERA DR SW, ALBUQUERQUE, NM 87151-1000
(505) 839-8974
Mailing address
5851 ANDERSON AVE SE APT 81, ALBUQUERQUE, NM 87108-5413
(505) 239-6106

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
X-10622
NM

Other

Enumeration date
11/19/2018
Last updated
11/19/2018
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