MEDICARE: MARGARITA QUEVADO LMT

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	225700000X	Massage Therapist	5808	NM

General Provider Information

NPI Number	:	1568097848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGARITA QUEVADO LMT

Provider Business Mailing Address
First Line	:	1229 S SAINT FRANCIS DR STE A
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-4052
Country	:	US
Telephone Number	:	505-310-1864
Fax Number	:

Provider Business Practice Location Address
First Line	:	1229 S SAINT FRANCIS DR STE A
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-4052
Country	:	US
Telephone Number	:	505-310-1864
Fax Number	:

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

Provider Enumeration Date	:	03/07/2020
Last Update Date	:	03/07/2020

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