Healthcare Provider Details

I. General information

NPI: 1639363930
Provider Name (Legal Business Name): MR. SONIA ESTRADA NAVARRETE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 ANTHONY DRIVE
ANTHONY NM
88021
US

IV. Provider business mailing address

PO BOX 8752
LAS CRUCES NM
88006-8752
US

V. Phone/Fax

Practice location:
  • Phone: 505-382-5998
  • Fax:
Mailing address:
  • Phone: 505-382-5998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: