Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner | NM |
NPI | 1003259805 |
---|---|
Provider Name | Ms. Alicia Jaramillo |
First Address | Albuquerque, NM 87105-4592 |
Second Address | Albuquerque, NM 87105-4592 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2013 |
Last Update Date | 25/04/2014 |