Healthcare Provider Details

I. General information

NPI: 1336648609
Provider Name (Legal Business Name): HAYLEY D ESCANDON RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HAYLEY D MURPHY RD, LD

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 02/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CEDAR ST SE STE 4660
ALBUQUERQUE NM
87106-4924
US

IV. Provider business mailing address

7101 VILLA CORRALES NE
ALBUQUERQUE NM
87113-1048
US

V. Phone/Fax

Practice location:
  • Phone: 505-563-6530
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberLD-0975
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: