Healthcare Provider Details

I. General information

NPI: 1598040099
Provider Name (Legal Business Name): RACHEL A MADRID
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2011
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 SUDDERTH DR
RUIDOSO NM
88345-6119
US

IV. Provider business mailing address

2002 SUDDERTH DR
RUIDOSO NM
88345-6119
US

V. Phone/Fax

Practice location:
  • Phone: 575-257-2368
  • Fax:
Mailing address:
  • Phone: 575-257-2368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number345807
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: