Individual
JOSE MARISCAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1817 YAKIMA LN, PUEBLO, CO 81001-1513
(719) 850-0550
Mailing address
1817 YAKIMA LN, PUEBLO, CO 81001-1513
(719) 850-0550
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
CO
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
CO
Other
Enumeration date
10/16/2020
Last updated
10/16/2020
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