Individual
JOHNNY BACA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
220 W 2ND ST, PORTALES, NM 88130-6232
(575) 356-2222
(575) 356-2224
Mailing address
PO BOX 28220, SANTA FE, NM 87592-8220
(505) 471-5006
(505) 820-9220
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
02/04/2011
Last updated
02/04/2011
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