Healthcare Provider Details

I. General information

NPI: 1437517570
Provider Name (Legal Business Name): PATRICIA VANESSA CHAPARRO RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6891 COYOTE RD
LAS CRUCES NM
88012-6517
US

IV. Provider business mailing address

6891 COYOTE RD
LAS CRUCES NM
88012-6517
US

V. Phone/Fax

Practice location:
  • Phone: 575-640-2896
  • Fax:
Mailing address:
  • Phone: 575-640-2896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH 3677
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: