Healthcare Provider Details

I. General information

NPI: 1740407188
Provider Name (Legal Business Name): DAWN CHERYL RAYMOND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4477 9TH AVENUE NE
RIO RANCHO NM
87124
US

IV. Provider business mailing address

6436 MATAMOROS RD NE
RIO RANCHO NM
87144
US

V. Phone/Fax

Practice location:
  • Phone: 505-862-7735
  • Fax: 505-896-6166
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberX05786
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: