Individual
IRIS G BACA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT 5746
Contact information
Practice address
1625 S MAIN ST, SUITE 5A, LAS CRUCES, NM 88005-6577
(575) 640-8344
Mailing address
PO BOX 7443, LAS CRUCES, NM 88006-7443
(575) 640-8344
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
5746
NM
Other
Enumeration date
07/23/2008
Last updated
07/23/2008
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