Individual
JORDAN CHAZ BACA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
901 GROVE ST NE, ALBUQUERQUE, NM 87110-7312
(505) 417-5632
Mailing address
901 GROVE ST NE, ALBUQUERQUE, NM 87110-7312
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
YIF905140520
—
NM
Enumeration date
06/25/2017
Last updated
06/25/2017
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