Individual
ROBERTO BACA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
232 RUSTLING WILLOW ST COMPLEX D, TOWAOC, CO 81334-0049
(970) 565-4441
(970) 565-9163
Mailing address
PO BOX 49, COMPLEX D RUSTLING WILLOW ST, TOWAOC, CO 81334-0049
(970) 565-4441
(970) 565-9163
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN-120269
CO
Other
Enumeration date
09/16/2009
Last updated
09/16/2009
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