Individual
GREGORY BUNDRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LISW
Contact information
Practice address
1206 NORTH RIVERSIDE DRIVE, AYUDANTES, ESAPNOLA, NM 87532
(505) 747-0102
Mailing address
12 GAVIOTA RD, SANTA FE, NM 87508-2124
(505) 699-5670
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
I06545
NM
Other
Enumeration date
07/21/2008
Last updated
07/21/2008
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