Healthcare Provider Details

I. General information

NPI: 1841242336
Provider Name (Legal Business Name): TRINIDAD DE JESUS ARGUELLO RN, LISW, PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 08/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 SIPAPU ROAD BOX 6952
TAOS NM
87571-6489
US

IV. Provider business mailing address

PO BOX 277
ARROYO SECO NM
87514-0277
US

V. Phone/Fax

Practice location:
  • Phone: 575-758-5857
  • Fax: 575-758-2832
Mailing address:
  • Phone: 575-776-2752
  • Fax: 575-758-2832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-2732
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR12314
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: