Provider Demographics
NPI:1053988667
Name:BACA, ERICA VALERIE
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:VALERIE
Last Name:BACA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5110 KENSINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-7458
Mailing Address - Country:US
Mailing Address - Phone:575-640-6584
Mailing Address - Fax:
Practice Address - Street 1:1320 S SOLANO DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3758
Practice Address - Country:US
Practice Address - Phone:575-522-4004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator