Individual
MIA R STREATER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1720 GERALDINE PL SE, RIO RANCHO, NM 87124-2746
(505) 681-3643
Mailing address
1720 GERALDINE PL SE, RIO RANCHO, NM 87124-2746
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/01/2018
Last updated
03/01/2018
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