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Individual

MRS. WALEMA IGNACIO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CMA

Contact information

Practice address
HIGHWAY 264 MILEPOST 388, POLACCA, AZ 86042
(928) 737-6000
Mailing address
HIGHWAY 264 MILEPOST 388, POLACCA, AZ 86042

Taxonomy

Speciality
Code
Description
License number
State
374700000X
Technician
Primary
2395549
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
020529
AZ
Enumeration date
12/09/2015
Last updated
12/09/2015
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