Healthcare Provider Details

I. General information

NPI: 1821702036
Provider Name (Legal Business Name): DANIEL JOSEPH FOLEY CPSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2023
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7409 KODIAK RD NE
RIO RANCHO NM
87144-8203
US

IV. Provider business mailing address

7409 KODIAK RD NE
RIO RANCHO NM
87144-8203
US

V. Phone/Fax

Practice location:
  • Phone: 206-659-2123
  • Fax:
Mailing address:
  • Phone: 206-659-2123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number1484
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: