Individual
JUANA CHARLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7 RIO SAN JOSE, LAGUNA, NM 87026
(505) 552-6513
Mailing address
7 RIO SAN JOSE, LAGUNA, NM 87026
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
502477331
—
NM
Enumeration date
10/01/2021
Last updated
10/01/2021
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