MEDICARE: TANYA MADRID

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1235465402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANYA MADRID

Provider Business Mailing Address
First Line	:	105 PASEO DEL CANON W STE A
Second Line	:
City	:	TAOS
State	:	NM
Zip	:	87571-6943
Country	:	US
Telephone Number	:	575-737-5533
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 7TH ST STE A
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4966
Country	:	US
Telephone Number	:	505-454-9611
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2009
Last Update Date	:	04/23/2026

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Directions to “ TANYA MADRID ” Practice Location

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