Healthcare Provider Details

I. General information

NPI: 1881995645
Provider Name (Legal Business Name): TASKER HATCH ROWAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 CABEZON BLVD SE
RIO RANCHO NM
87124-1515
US

IV. Provider business mailing address

325 S HIGLEY RD #130
GILBERT AZ
85296
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-5437
  • Fax:
Mailing address:
  • Phone: 505-850-3769
  • Fax: 505-890-2949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: EBONIE GONZALES
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 505-850-3769