Individual
MARYLOU BACA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
707 PASEO DE PERALTA, SANTA FE, NM 87501-1922
(505) 989-8707
(505) 989-3536
Mailing address
707 PASEO DE PERALTA, SANTA FE, NM 87501-1922
(505) 577-4543
(505) 989-3536
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
85944
NM
Other
Enumeration date
11/12/2025
Last updated
11/12/2025
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