Healthcare Provider Details

I. General information

NPI: 1831659754
Provider Name (Legal Business Name): LELILAH TODACHEENE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 CAMINA REAL
FARMINGTON NM
87401
US

IV. Provider business mailing address

2001 N DUSTIN AVE
FARMINGTON NM
87401-2120
US

V. Phone/Fax

Practice location:
  • Phone: 505-599-8603
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberM-10061
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: