Healthcare Provider Details

I. General information

NPI: 1265020135
Provider Name (Legal Business Name): ANTONIO ARAGON CPHRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2021
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 EUBANK BLVD NE STE A
ALBUQUERQUE NM
87112-1300
US

IV. Provider business mailing address

2801 EUBANK BLVD NE STE A
ALBUQUERQUE NM
87112-1300
US

V. Phone/Fax

Practice location:
  • Phone: 505-294-1597
  • Fax: 505-275-0340
Mailing address:
  • Phone: 505-294-1597
  • Fax: 505-275-0340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: