Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 487 | NM |
NPI | 1164456208 |
---|---|
Provider Name | Mrs. Eunice Baca Pino |
First Address | Albuquerque, NM 87120-1710 |
Second Address | Albuquerque, NM 87109-2100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 21/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
70478741 | (05) | NM |
P69136 | (02) |