Individual
BRIANA FOUNTAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4705 PALMAS ALTAS DR SE, RIO RANCHO, NM 87124-1330
(505) 385-5463
Mailing address
4705 PALMAS ALTAS DR SE, RIO RANCHO, NM 87124-1330
(505) 385-5463
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Enumeration date
07/09/2018
Last updated
07/09/2018
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