Healthcare Provider Details

I. General information

NPI: 1912682824
Provider Name (Legal Business Name): RAQUEL BEGAY CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W BROADWAY STE D
FARMINGTON NM
87401-5638
US

IV. Provider business mailing address

1001 W BROADWAY STE D
FARMINGTON NM
87401-5638
US

V. Phone/Fax

Practice location:
  • Phone: 505-327-4796
  • Fax: 505-324-1039
Mailing address:
  • Phone: 505-327-4796
  • Fax: 505-324-1039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: