Individual
VICTORIA M BACA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2301 7TH ST STE A, LAS VEGAS, NM 87701-4966
(505) 454-9611
(505) 454-8079
Mailing address
2301 7TH ST STE A, LAS VEGAS, NM 87701-4966
(505) 454-9611
(505) 454-8079
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
83774556
—
NM
Enumeration date
11/01/2019
Last updated
11/01/2019
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