Healthcare Provider Details

I. General information

NPI: 1689908147
Provider Name (Legal Business Name): TALIA R. WOOD R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 GOAT SPRINGS ROAD
TAOS NM
87571-1946
US

IV. Provider business mailing address

P.O. BOX 1946 1090 GOAT SPRINGS ROAD
TAOS NM
87571-1946
US

V. Phone/Fax

Practice location:
  • Phone: 575-758-4224
  • Fax: 575-751-5210
Mailing address:
  • Phone: 575-758-4224
  • Fax: 575-751-5210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD-0623
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: