Healthcare Provider Details

I. General information

NPI: 1174446777
Provider Name (Legal Business Name): ANGELIQUE JOCELYN BARRON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 MAIN ST NW STE 1&2
LOS LUNAS NM
87031-4812
US

IV. Provider business mailing address

1400 MAIN ST NW STE 1&2
LOS LUNAS NM
87031-4812
US

V. Phone/Fax

Practice location:
  • Phone: 505-865-4368
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPT-2026-0222
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: