Healthcare Provider Details

I. General information

NPI: 1912628306
Provider Name (Legal Business Name): AMARIS MOYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 5TH ST SE
RIO RANCHO NM
87124-2705
US

IV. Provider business mailing address

6001 WHITEMAN DR NW
ALBUQUERQUE NM
87120-2196
US

V. Phone/Fax

Practice location:
  • Phone: 505-388-6843
  • Fax:
Mailing address:
  • Phone: 505-717-1155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: