Healthcare Provider Details

I. General information

NPI: 1821474396
Provider Name (Legal Business Name): CZARINO PARAGAS SILAO P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2015
Last Update Date: 12/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 N MAIN ST
ROSWELL NM
88201-4722
US

IV. Provider business mailing address

PO BOX 3893
ROSWELL NM
88202-3893
US

V. Phone/Fax

Practice location:
  • Phone: 575-625-2525
  • Fax: 575-627-5934
Mailing address:
  • Phone: 575-625-2525
  • Fax: 575-627-5934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4175
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: