Healthcare Provider Details

I. General information

NPI: 1295544047
Provider Name (Legal Business Name): MEDICALON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2749 WILDER LOOP NE
RIO RANCHO NM
87144-1441
US

IV. Provider business mailing address

2749 WILDER LOOP NE
RIO RANCHO NM
87144-1441
US

V. Phone/Fax

Practice location:
  • Phone: 505-604-5838
  • Fax:
Mailing address:
  • Phone: 505-604-5838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TYLER AARON NAFUS
Title or Position: PRESIDENT
Credential: RN-BSN
Phone: 505-604-5838