Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 98-34 | NM |
NPI | 1083736136 |
---|---|
Provider Name | Wanicha Buraphacheep-Coggins |
First Address | Santa Fe, NM 87505-5472 |
Second Address | Santa Fe, NM 87505-5472 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 08/07/2007 |