Individual
MRS. ELIZABETH MANGUAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
255A S CAMINO DEL PUEBLO, BERNALILLO, NM 87004-5973
(505) 867-2356
(505) 867-2357
Mailing address
255A S CAMINO DEL PUEBLO, BERNALILLO, NM 87004-5973
(505) 867-2356
(505) 867-2357
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
01799924003
NM
Other
Enumeration date
01/11/2012
Last updated
01/11/2012
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