| Greg Baca MD, LLC | |
|
464 Central Ave Suite 4 Los Alamos NM 87544-3350 | |
| (505) 795-5217 | |
| Not Available |
| Full Name | Greg Baca MD, LLC |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 464 Central Ave, Los Alamos, New Mexico |
| Authorized Official Name and Position | Gregory K Baca (OWNER) |
| Authorized Official Contact | 5057955217 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Greg Baca MD, LLC 112 Grand Canyon Dr Los Alamos NM 87544-3423 Ph: (505) 795-5217 | Greg Baca MD, LLC 464 Central Ave Suite 4 Los Alamos NM 87544-3350 Ph: (505) 795-5217 |
| NPI Number | 1457789125 |
|---|---|
| Provider Enumeration Date | 10/16/2013 |
| Last Update Date | 10/16/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457789125 | NPI | - | NPPES |
| 13252291 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | MD2008-0553 (New Mexico) | Primary |
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