Healthcare Provider Details

I. General information

NPI: 1972260446
Provider Name (Legal Business Name): MONIQUE LANAYA TAFOYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 COURTHOUSE RD SE
LOS LUNAS NM
87031-9596
US

IV. Provider business mailing address

475 COURTHOUSE RD SE
LOS LUNAS NM
87031-9596
US

V. Phone/Fax

Practice location:
  • Phone: 505-508-3503
  • Fax: 505-312-8480
Mailing address:
  • Phone: 505-508-3503
  • Fax: 505-312-8480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number516069571
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: