Most Relevant Information
Provider Data
| NPI Number: | 1003585647 |
| Provider Name: | GABRIELA BACA |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/08/2021 |
| Last Updated: | 09/08/2021 |
Provider Practice Location
1500 S AVENUE K
STATION 3, SHROC
PORTALES
NM
88130
Practice Location Phone/Fax
| Phone: | 5059278228 |
| Fax: |
Provider Mailing Location
1500 S AVENUE K
PORTALES
NM
881307400
Provider Mailing Phone/Fax
| Phone: | 5059278228 |
| Fax: |