Individual
ALYSSIA RAMONA BACA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AA
Contact information
Practice address
324 JUAN MEDINA ROAD, CHIMAYO, NM 87522
(505) 927-1303
Mailing address
324 JUAN MEDINA ROAD, CHIMAYO, NM 87522
(505) 927-1303
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
08/06/2019
Last updated
08/06/2019
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