Individual
DR. RANDOLPH P BACA JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1003 LUNA CIR NW, ALBUQUERQUE, NM 87102-1973
(505) 504-5505
(505) 214-5614
Mailing address
PO BOX 95602, ALBUQUERQUE, NM 87199
(505) 504-5505
(505) 214-5614
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
AG3361893-B416
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
13558242
—
NM
Enumeration date
07/02/2007
Last updated
08/29/2023
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