Healthcare Provider Details

I. General information

NPI: 1396058079
Provider Name (Legal Business Name): ROSITA'
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2010
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 TOADLENA MEADOWS DR NE
RIO RANCHO NM
87144-0542
US

IV. Provider business mailing address

825 TOADLENA MEADOWS DR NE
RIO RANCHO NM
87144-0542
US

V. Phone/Fax

Practice location:
  • Phone: 505-818-1846
  • Fax:
Mailing address:
  • Phone: 505-818-1846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberM-05024
License Number StateNM

VIII. Authorized Official

Name: MRS. ROSITA A. MOYA-HERRERA
Title or Position: THERAPIST
Credential: LMSW
Phone: 505-771-5958