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NPI Code Detail

MEDICARE: RONNIE JAMES BACA

MEDICARE: RONNIE JAMES BACA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WC0200XCritical Care Medicine Registered Nurse82267NM

General Provider Information

NPI Number : 1427833094
Entity Type Code : Individual
Provider Name (Legal Business Name) : RONNIE JAMES BACA
Provider Business Mailing Address
First Line : 4220 N ARROWHEAD RD
Second Line :
City : SILVER CITY
State : NM
Zip : 88061-6034
Country : US
Telephone Number : 575-956-7919
Fax Number :
Provider Business Practice Location Address
First Line : 4220 N ARROWHEAD RD
Second Line :
City : SILVER CITY
State : NM
Zip : 88061-6034
Country : US
Telephone Number : 575-956-7919
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2023
Last Update Date : 08/30/2023

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Directions to “ RONNIE JAMES BACA ” Practice Location

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