Healthcare Provider Details

I. General information

NPI: 1376358325
Provider Name (Legal Business Name): NAOMI RONQUILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 W 2ND ST
ROSWELL NM
88201-2013
US

IV. Provider business mailing address

700 S SUNSET AVE APT E
ROSWELL NM
88203-2857
US

V. Phone/Fax

Practice location:
  • Phone: 575-623-2615
  • Fax:
Mailing address:
  • Phone: 575-495-1028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: