Healthcare Provider Details

I. General information

NPI: 1700771391
Provider Name (Legal Business Name): RAYMOND N POVIJUA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 32
OHKAY OWINGEH NM
87566-0032
US

IV. Provider business mailing address

PO BOX 32
OHKAY OWINGEH NM
87566-0032
US

V. Phone/Fax

Practice location:
  • Phone: 505-929-0217
  • Fax:
Mailing address:
  • Phone: 505-929-0217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: