Individual
SUSANA VEGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5305 MCNUTT RD, SANTA TERESA, NM 88008-9685
(575) 882-5100
(575) 882-1151
Mailing address
PO BOX 2671, ANTHONY, NM 88021-2671
(575) 882-5100
(575) 882-1151
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
07/02/2019
Last updated
05/21/2021
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