Individual
CORAL JANE WAGGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPSGT, RRT,CCSH,MBA
Contact information
Practice address
4700 JEFFERSON ST NE STE 800, ALBUQUERQUE, NM 87109-2132
(505) 872-6005
(515) 872-6003
Mailing address
1869 MONTARA CT NW, LOS LUNAS, NM 87031-8384
(505) 872-6005
(505) 872-6003
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
PT2013-0001
NM
Other
Enumeration date
04/03/2018
Last updated
04/03/2018
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