Healthcare Provider Details

I. General information

NPI: 1467334144
Provider Name (Legal Business Name): JARED AUSTIN GARAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 31 BOX 18
DERRY NM
87933-9601
US

IV. Provider business mailing address

HC 31 BOX 18
DERRY NM
87933-9601
US

V. Phone/Fax

Practice location:
  • Phone: 575-649-3077
  • Fax:
Mailing address:
  • Phone: 575-649-3077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: