Healthcare Provider Details

I. General information

NPI: 1114689189
Provider Name (Legal Business Name): MS. BEATRIZ G PAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2021
Last Update Date: 10/07/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 HOPI DR
QUEMADO NM
87829-9131
US

IV. Provider business mailing address

HC 32 BOX 706
QUEMADO NM
87829-9613
US

V. Phone/Fax

Practice location:
  • Phone: 520-820-3545
  • Fax:
Mailing address:
  • Phone: 520-820-3574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: