Individual
KAIBAH GORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
815 W APACHE ST, FARMINGTON, NM 87401-5527
(505) 325-5358
(505) 326-3085
Mailing address
807 W APACHE ST, FARMINGTON, NM 87401-5527
(505) 325-5358
(505) 326-3085
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
07/09/2018
Last updated
07/09/2018
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