Individual
MISS ALISHA M BACOCCINI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
10705 MALAGUENA LN NE, ALBUQUERQUE, NM 87111-6819
(505) 681-2259
Mailing address
10705 MALAGUENA LN NE, ALBUQUERQUE, NM 87111-6819
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
5666
NM
Other
Enumeration date
01/06/2009
Last updated
01/06/2009
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