Healthcare Provider Details

I. General information

NPI: 1649980897
Provider Name (Legal Business Name): ISABEL JARAMILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 E 30TH ST
FARMINGTON NM
87402-8805
US

IV. Provider business mailing address

401 PIMA AVE
FARMINGTON NM
87401-4606
US

V. Phone/Fax

Practice location:
  • Phone: 505-324-9840
  • Fax:
Mailing address:
  • Phone: 505-419-3936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberSWB-2023-0710
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: