Most Relevant Information
Provider Data
| NPI Number: | 1003450404 |
| Provider Name: | ROSALBA I PONCE REYES |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 10/30/2019 |
| Last Updated: | 12/02/2019 |
Provider Practice Location
187B SUNRISE RD
SANTA FE
NM
875073781
Practice Location Phone/Fax
| Phone: | 5055777685 |
| Fax: |
Provider Mailing Location
187B SUNRISE RD
SANTA FE
NM
875073781
Provider Mailing Phone/Fax
| Phone: | 5055777685 |
| Fax: |