Healthcare Provider Details

I. General information

NPI: 1912447269
Provider Name (Legal Business Name): MAGDALENA SAENZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2017
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 W MANANA BLVD
CLOVIS NM
88101-4209
US

IV. Provider business mailing address

440 W MANANA BLVD
CLOVIS NM
88101-4209
US

V. Phone/Fax

Practice location:
  • Phone: 575-313-5177
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number505382269
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: