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Individual

ALICIA PUEBLO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
524 W CENTRE AVE, PORTAGE, MI 49024-5306
(269) 324-1180
Mailing address
2404 HAZEL AVE, KALAMAZOO, MI 49008-2714

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703114479
MI

Other

Enumeration date
09/12/2019
Last updated
09/12/2019
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