Individual
MRS. DAMANI TRYON PSR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
184 UNSER BLVD NE, RIO RANCHO, NM 87124-4045
(505) 896-0928
Mailing address
184 UNSER BLVD NE, RIO RANCHO, NM 87124-4045
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1467975763
—
NM
Enumeration date
07/19/2017
Last updated
08/28/2019
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