Healthcare Provider Details

I. General information

NPI: 1649620550
Provider Name (Legal Business Name): MRS. CHERIE ERLENE ORTIZ-RIOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS CHERIE ERLENE ORTIZ

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3B CORAL ST
SANTA FE NM
87506-9301
US

IV. Provider business mailing address

3B CORAL ST
SANTA FE NM
87506-9301
US

V. Phone/Fax

Practice location:
  • Phone: 505-469-8279
  • Fax:
Mailing address:
  • Phone: 505-469-8279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: