Individual
KATHY TITLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1415 ELVA DR, GALLUP, NM 87301-5823
(505) 325-5358
Mailing address
807 W APACHE ST, FARMINGTON, NM 87401-5527
(505) 325-5358
(505) 326-3085
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
11/09/2018
Last updated
11/09/2018
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