Healthcare Provider Details

I. General information

NPI: 1457794349
Provider Name (Legal Business Name): RICHARD EARNEST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2432 CERRILLOS RD
SANTA FE NM
87505-3392
US

IV. Provider business mailing address

2432 CERRILLOS RD
SANTA FE NM
87505
US

V. Phone/Fax

Practice location:
  • Phone: 505-424-1066
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number80581
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number0852
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: