Individual
MYTYL RENEE SALAZAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
102 S. NOGAL AVE., CAPITAN, NM 88316-0611
(575) 937-9193
Mailing address
PO BOX 611, CAPITAN, NM 88316
(575) 937-9193
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
11/02/2017
Last updated
11/02/2017
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