MEDICARE: MRS. TRINIDAD DE JESUS ARGUELLO RN, LISW, PH.D

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
1	1041C0700X	Clinical Social Worker	I-2732	NM
2	163W00000X	Registered Nurse	R12314	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841242336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRINIDAD DE JESUS ARGUELLO RN, LISW, PH.D

Provider Business Mailing Address
First Line	:	PO BOX 277
Second Line	:
City	:	ARROYO SECO
State	:	NM
Zip	:	87514-0277
Country	:	US
Telephone Number	:	575-776-2752
Fax Number	:	575-758-2832

Provider Business Practice Location Address
First Line	:	413 SIPAPU ROAD
Second Line	:	BOX 6952
City	:	TAOS
State	:	NM
Zip	:	87571-6489
Country	:	US
Telephone Number	:	575-758-5857
Fax Number	:	575-758-2832

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	08/15/2008

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