Individual
DR. JANET C'DE BACA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1501 SAN PEDRO DR SE, ALBUQUERQUE, NM 87108-5153
(505) 265-1711
Mailing address
457 ASBURY RD NE, RIO RANCHO, NM 87124-5632
(505) 994-1094
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0832
NM
Other
Enumeration date
05/12/2007
Last updated
07/08/2007
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