Individual
THALIA VENERABLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2074 GALISTEO ST STE A4, SANTA FE, NM 87505-2104
(505) 795-1804
Mailing address
1704B LLANO ST # 144, SANTA FE, NM 87505-5460
(505) 795-1804
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
O225
NM
Other
Enumeration date
01/06/2011
Last updated
01/06/2011
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