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General NPI Number Information
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NPI Number | 1922064104
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Entity Type | Individual
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Provider Name | RONALD J MALOTT LADAC
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Gender | Male
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 01/26/2015
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Provider Practice Location Address
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Address Line | 213 N. 2ND STREET
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City | RATON
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State | NM
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Zip | 87740
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Country | US
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Telephone | 575-445-9761
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Fax | 575-445-2887
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Provider Business Mailing Address
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Address Line | RR 1 BOX 56A
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City | SPRINGER
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State | NM
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Zip | 87747-9703
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Country | US
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Telephone | 575-483-2480
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 3757
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License Number State | NM
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