Individual
BEVERLY BACA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CSW
Contact information
Practice address
900 MARSHALL ST, TRUTH OR CONSEQUENCES, NM 87901-6600
(575) 288-5773
Mailing address
900 MARSHALL ST, TRUTH OR CONSEQUENCES, NM 87901-6600
(575) 288-5773
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
053210066
DRIVER LICENSE
NM
Enumeration date
01/06/2022
Last updated
01/06/2022
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