Healthcare Provider Details

I. General information

NPI: 1639469984
Provider Name (Legal Business Name): ROBERT ARAGON P.T.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 MILLS AVE
LAS VEGAS NM
87701-4664
US

IV. Provider business mailing address

PO BOX 1917
LAS VEGAS NM
87701-1917
US

V. Phone/Fax

Practice location:
  • Phone: 505-425-2998
  • Fax: 505-425-2897
Mailing address:
  • Phone: 505-227-1998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA-0780
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: