Healthcare Provider Details

I. General information

NPI: 1689342164
Provider Name (Legal Business Name): JUAN MURO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CAMINO ORO CT
TIJERAS NM
87059-7924
US

IV. Provider business mailing address

1 CAMINO ORO CT
TIJERAS NM
87059-7924
US

V. Phone/Fax

Practice location:
  • Phone: 505-274-8534
  • Fax:
Mailing address:
  • Phone: 505-274-8534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number1207
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCTB-2026-0203
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: