Healthcare Provider Details

I. General information

NPI: 1891956512
Provider Name (Legal Business Name): MONICA ELAINE DAWSON M.ED, MLT, CT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 37TH ST SE
RIO RANCHO NM
87124-1812
US

IV. Provider business mailing address

1504 37TH ST SE
RIO RANCHO NM
87124-1812
US

V. Phone/Fax

Practice location:
  • Phone: 505-994-0350
  • Fax: 505-994-0350
Mailing address:
  • Phone: 505-994-0350
  • Fax: 505-994-0350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number2040
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: