Healthcare Provider Details

I. General information

NPI: 1487070355
Provider Name (Legal Business Name): ROSALINDA G RIVERA MORALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2014
Last Update Date: 10/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 W BROADWAY
HOBBS NM
88240
US

IV. Provider business mailing address

PO BOX 907
HOBBS NM
88241-0907
US

V. Phone/Fax

Practice location:
  • Phone: 575-393-3168
  • Fax: 575-397-4659
Mailing address:
  • Phone: 575-393-3168
  • Fax: 575-397-4659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: