Individual
SHADI KAMAL JAWAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1855 SIGMA CHI RD NE, ALBUQUERQUE, NM 87106-3816
Mailing address
1508 FAIRWAYS CIR, GALLUP, NM 87301-4937
(505) 879-0043
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10204943900
CENTENNIAL CARE
NM
Enumeration date
11/27/2018
Last updated
11/27/2018
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