Healthcare Provider Details

I. General information

NPI: 1699471615
Provider Name (Legal Business Name): AUDRIE RIOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 02/01/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 W HEMLOCK ST
DEMING NM
88030-3622
US

IV. Provider business mailing address

222 S TIN ST
DEMING NM
88030-3645
US

V. Phone/Fax

Practice location:
  • Phone: 575-694-5478
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: