Healthcare Provider Details

I. General information

NPI: 1619200367
Provider Name (Legal Business Name): JOE D TUMALAD NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 07/19/2022
Certification Date: 07/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 MECHEM DR STE 1
RUIDOSO NM
88345-7207
US

IV. Provider business mailing address

1204 MECHEM DR STE 1
RUIDOSO NM
88345-7207
US

V. Phone/Fax

Practice location:
  • Phone: 281-444-1711
  • Fax: 281-456-3437
Mailing address:
  • Phone: 575-808-8297
  • Fax: 575-449-2623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number564554
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: