Individual
BIANCA CELEST VEGA I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2408 MICHELLE RD SW, ALBUQUERQUE, NM 87105-4920
(505) 357-8498
Mailing address
2408 MICHELLE RD SW, ALBUQUERQUE, NM 87105-4920
(505) 217-4603
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
516814152
NM
Other
Enumeration date
07/20/2023
Last updated
07/20/2023
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