Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 2670 | NM |
NPI | 1003129545 |
---|---|
Provider Name | Rosalinda Barraza |
First Address | Lovington, NM 88260 |
Second Address | Lovington, NM 88260 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2010 |
Last Update Date | 26/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12874281 | (05) | NM |