Individual
SAMANTHA BACA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C.
Contact information
Practice address
1821 CARLISLE BLVD NE, ALBUQUERQUE, NM 87110-4905
(505) 255-1228
(505) 255-1394
Mailing address
800 BRADBURY DR SE STE 116, ALBUQUERQUE, NM 87106-4310
(505) 272-1476
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2014-0073
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
77330811
—
NM
Enumeration date
08/24/2009
Last updated
01/02/2025
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