Healthcare Provider Details

I. General information

NPI: 1740113190
Provider Name (Legal Business Name): RICHIE NEZ SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CEDAR HILLS RD 20 CEDAR HILLS RD
GANADO AZ
86505-0305
US

IV. Provider business mailing address

PO BOX 305 20 CEDAR HILLS RD
GANADO AZ
86505-0305
US

V. Phone/Fax

Practice location:
  • Phone: 928-755-4431
  • Fax: 928-755-4430
Mailing address:
  • Phone: 928-755-4431
  • Fax: 928-755-4430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberL15252856
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: