Healthcare Provider Details

I. General information

NPI: 1780414003
Provider Name (Legal Business Name): NAOMI MARISOL HERRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2024
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W ELM ST
DEMING NM
88030-4123
US

IV. Provider business mailing address

310 W ELM ST
DEMING NM
88030-4123
US

V. Phone/Fax

Practice location:
  • Phone: 575-546-0427
  • Fax:
Mailing address:
  • Phone: 575-546-0427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: