Individual
DR. LAURA SPROSTON JAQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2130 FARMINGTON AVE STE A, FARMINGTON, NM 87401
(505) 325-2323
(505) 325-7172
Mailing address
2130 FARMINGTON AVE STE A, FARMINGTON, NM 87401-2123
(505) 325-2323
(505) 325-7172
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2001-314
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
24906255
—
NM
Enumeration date
07/12/2006
Last updated
10/17/2018
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