Healthcare Provider Details

I. General information

NPI: 1619835030
Provider Name (Legal Business Name): XAVIER ROBINSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2026
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 MEADOWLARK LN SE STE 3
RIO RANCHO NM
87124-1050
US

IV. Provider business mailing address

4200 MEADOWLARK LN SE STE 3
RIO RANCHO NM
87124-1050
US

V. Phone/Fax

Practice location:
  • Phone: 505-340-8760
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number22041
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: