Healthcare Provider Details

I. General information

NPI: 1194975847
Provider Name (Legal Business Name): FABRION OF NM D/B/A RIO GRANDE ERRANDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 09/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 ELM ST
MAGDALENA NM
87825
US

IV. Provider business mailing address

PO BOX 2764
MORIARTY NM
87035-2764
US

V. Phone/Fax

Practice location:
  • Phone: 505-832-9496
  • Fax:
Mailing address:
  • Phone: 505-832-9496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MR. EARLE BOYER
Title or Position: OWNER
Credential:
Phone: 505-832-9496