Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225CA2400X | Assistive Technology Practitioner | 4622 | NM |
NPI | 1700167939 |
---|---|
Provider Name | Mr. Alfonso Terrazas |
First Address | Albuquerque, NM 87113-1028 |
Second Address | Albuquerque, NM 87113-1028 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2011 |
Last Update Date | 01/09/2011 |