Healthcare Provider Details

I. General information

NPI: 1437488830
Provider Name (Legal Business Name): RUBEN CARMONA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2009
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 ANTHONY DR STE 3E
ANTHONY NM
88021-9346
US

IV. Provider business mailing address

880 ANTHONY DR STE 3E
ANTHONY NM
88021-9346
US

V. Phone/Fax

Practice location:
  • Phone: 575-882-5290
  • Fax:
Mailing address:
  • Phone: 575-882-5290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNM

VIII. Authorized Official

Name: MISS ARCILIA HOLGUIN
Title or Position: CEO
Credential: MA LPCC
Phone: 575-882-5290