Healthcare Provider Details

I. General information

NPI: 1619769197
Provider Name (Legal Business Name): RONANADO ESALIO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 APACHE AVE
SANTA FE NM
87505-3212
US

IV. Provider business mailing address

52 BONANZA TRL
SANTA FE NM
87508-1534
US

V. Phone/Fax

Practice location:
  • Phone: 310-721-4398
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: