Individual
AMANDA DANIELLE FRAGOSO MONTANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
339 NARA VISA CT NW, LOS RANCHOS, NM 87107-6155
(505) 554-8033
Mailing address
339 NARA VISA CT NW, LOS RANCHOS, NM 87107-6155
(150) 555-4803
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/07/2022
Last updated
07/07/2022
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