Healthcare Provider Details

I. General information

NPI: 1902679996
Provider Name (Legal Business Name): DONNA R ARAGON I BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DONNA R ARAGON I BSW

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 LOS LENTES RD SE
LOS LUNAS NM
87031-6018
US

IV. Provider business mailing address

428 LOS LENTES RD SE
LOS LUNAS NM
87031-6018
US

V. Phone/Fax

Practice location:
  • Phone: 505-780-4114
  • Fax: 505-780-4114
Mailing address:
  • Phone: 505-780-4114
  • Fax: 505-780-4114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: