Healthcare Provider Details

I. General information

NPI: 1912516022
Provider Name (Legal Business Name): PRAMESH BARAL M
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2020
Last Update Date: 10/18/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3777 NM-528 NE
RIO RANCHO NM
87144
US

IV. Provider business mailing address

3777 NM-528 NE
RIO RANCHO NM
87144
US

V. Phone/Fax

Practice location:
  • Phone: 505-404-2590
  • Fax:
Mailing address:
  • Phone: 505-404-2590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2023-0290
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: