Individual
JUSTIN BAILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
105 BERTHA RD STE B, TAOS, NM 87571-7148
(575) 758-4297
Mailing address
7193 HIGHWAY 518, RANCHOS DE TAOS, NM 87557-9758
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
08/28/2023
Last updated
12/22/2023
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