Healthcare Provider Details

I. General information

NPI: 1578969499
Provider Name (Legal Business Name): GREGORIA KAY RIROU MA, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2014
Last Update Date: 11/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 SEDONA MEADOWS DR NE
RIO RANCHO NM
87144-8535
US

IV. Provider business mailing address

524 SEDONA MEADOWS DRIVE NE
RIO RANCHO NM
87144
US

V. Phone/Fax

Practice location:
  • Phone: 505-385-8620
  • Fax:
Mailing address:
  • Phone: 505-385-8620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM-1020
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: