Individual
BETHANY BACA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1636 COLUMBIA DR SE, ALBUQUERQUE, NM 87106-3302
(505) 907-1583
Mailing address
1636 COLUMBIA DR SE, ALBUQUERQUE, NM 87106-3302
(505) 907-1583
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
500664169
NM
Other
Enumeration date
07/28/2016
Last updated
07/28/2016
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