Healthcare Provider Details

I. General information

NPI: 1477198968
Provider Name (Legal Business Name): MICHELLE MARIE TAFOYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2019
Last Update Date: 10/29/2021
Certification Date: 10/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 LOS LENTES RD NE
LOS LUNAS NM
87031-9337
US

IV. Provider business mailing address

707 BROADWAY BLVD NE
ALBUQUERQUE NM
87102-2360
US

V. Phone/Fax

Practice location:
  • Phone: 505-321-5254
  • Fax: 505-271-4957
Mailing address:
  • Phone: 505-345-8471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: