Individual
MAXILEA ISOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2079 EGLIN AVE APT A, HOLLOMAN, AFB, NM 88330
(347) 485-8386
Mailing address
2079 EGLIN AVE APT A, HOLLOMAN AFB, NM 88330-7209
(347) 485-8386
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/03/2017
Last updated
05/03/2017
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