Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 338953 | NM |
NPI | 1023620663 |
---|---|
Provider Name | Mr. Jose Fabio Flores Villalobos |
First Address | Silver City, NM 88061-5853 |
Second Address | Silver City, NM 88061-5853 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2020 |
Last Update Date | 17/08/2020 |