Provider Information for 1215129143
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LETHA SUE OLMOS LISW
Sex: Female
NPI: 1215129143
Last Updated: 2012-10-22
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
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| NPI | 1215129143 | ||||||||||||
| Enumeration Date | 2007-08-14 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 540 CHAMA ST NE ALBUQUERQUE, NM 87108 United States Phone: 505-265-0753 | Fax:505-268-5722 | ||||||||||||
| Primary Practice Address | 540 CHAMA ST. NE ALBUQUERQUE, NM 87108 United States Phone: 505-265-0753 | Fax:505-268-5722 | ||||||||||||
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