Healthcare Provider Details

I. General information

NPI: 1538037502
Provider Name (Legal Business Name): DAVID NORIEGA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W COUNTRY CLUB RD STE 102
ROSWELL NM
88201-5227
US

IV. Provider business mailing address

601 W COUNTRY CLUB RD STE 102
ROSWELL NM
88201-5227
US

V. Phone/Fax

Practice location:
  • Phone: 505-601-6081
  • Fax: 505-925-0085
Mailing address:
  • Phone: 505-601-6081
  • Fax: 505-925-0085

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: