Healthcare Provider Details

I. General information

NPI: 1811021926
Provider Name (Legal Business Name): RICHARD ARMIJO MA BSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 DOUGLAS AVE
LAS VEGAS NM
87701-3928
US

IV. Provider business mailing address

733 E TILDEN ST
LAS VEGAS NM
87701-3822
US

V. Phone/Fax

Practice location:
  • Phone: 505-454-5700
  • Fax: 505-454-5702
Mailing address:
  • Phone: 505-425-2886
  • Fax: 505-454-5702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberB-1474
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: