Individual
JERRICA SHAYLENE BACA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
41521 W. 11 MILE RD NOBI, NOBI, MI 48375
(505) 570-9135
Mailing address
41521 W. 11 MILE RD, NOBI, MI 48375
(505) 570-9135
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3735825652
—
NM
Enumeration date
11/08/2016
Last updated
11/08/2016
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