Healthcare Provider Details

I. General information

NPI: 1285049478
Provider Name (Legal Business Name): TASHINA B NEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 E 30TH ST STE A
FARMINGTON NM
87402-8805
US

IV. Provider business mailing address

3401 E 30TH ST STE A
FARMINGTON NM
87402-8805
US

V. Phone/Fax

Practice location:
  • Phone: 505-599-8617
  • Fax: 855-290-2205
Mailing address:
  • Phone: 505-599-8617
  • Fax: 855-290-2205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberSWB-2024-0615
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: