Healthcare Provider Details

I. General information

NPI: 1417869157
Provider Name (Legal Business Name): MANUEL PAZ SOLDAN FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W MAPLE ST STE B
FARMINGTON NM
87401-6589
US

IV. Provider business mailing address

622 W MAPLE ST STE B
FARMINGTON NM
87401-6589
US

V. Phone/Fax

Practice location:
  • Phone: 505-327-4867
  • Fax: 505-327-5355
Mailing address:
  • Phone: 505-327-4867
  • Fax: 505-327-5355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number64780
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: