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Individual

DIANNA RUTH BACA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
8920 HOLLY AVE NE, SUITE 102-B, ALBUQUERQUE, NM 87122-2988
(505) 385-2365
Mailing address
8920 HOLLY AVE NE SUITE 102-B, ALBUQUERQUE, NM 87122
(505) 385-2365

Taxonomy

Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary

Other

Enumeration date
07/18/2016
Last updated
07/18/2016
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