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Individual

TINA MARIE GARLAND

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
904 E FAIRVIEW LN, ESPANOLA, NM 87532-2822
(505) 747-1991
(505) 753-6462
Mailing address
PO BOX 3157, ESPANOLA, NM 87533-3157
(505) 747-1991
(505) 753-6462

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
019629325
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
17
17
NM
Enumeration date
10/09/2009
Last updated
10/09/2009
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