Healthcare Provider Details

I. General information

NPI: 1508448382
Provider Name (Legal Business Name): ROSALIE GUEVARRA MASCARDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROSALIE GUEVARRA

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 E NIZHONI BLVD
GALLUP NM
87301-5748
US

IV. Provider business mailing address

222 E NIZHONI BLVD APT B8
GALLUP NM
87301-7128
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-1000
  • Fax:
Mailing address:
  • Phone: 214-430-0033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number894664
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: