Healthcare Provider Details

I. General information

NPI: 1144561069
Provider Name (Legal Business Name): MR. RAMON GABRIEL ESQUIBEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2013
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 HOT SPRINGS BLVD
LAS VEGAS NM
87701-4119
US

IV. Provider business mailing address

HC 69 BOX 3001
ROCIADA NM
87742-9710
US

V. Phone/Fax

Practice location:
  • Phone: 505-304-0098
  • Fax: 505-454-4832
Mailing address:
  • Phone: 505-454-4832
  • Fax: 505-454-4832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6911
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: