Healthcare Provider Details

I. General information

NPI: 1447114111
Provider Name (Legal Business Name): DYLAN MATTHEWS RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 9TH ST
ALAMOGORDO NM
88310-6416
US

IV. Provider business mailing address

3023 SUNRISE AVE
ALAMOGORDO NM
88310-4046
US

V. Phone/Fax

Practice location:
  • Phone: 575-495-9911
  • Fax:
Mailing address:
  • Phone: 575-446-2057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-499548
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: