Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | PA55605 | CA |
NPI | 1174016455 |
---|---|
Provider Name | Claire Marie Pultz |
First Address | Albuquerque, NM 87122-3377 |
Second Address | Albuquerque, NM 87106-2719 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2018 |
Last Update Date | 10/06/2020 |