Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | CNP-01999 | NM |
NPI | 1003162736 |
---|---|
Provider Name | Mr. Jimmy Maggay Calzado |
First Address | Rio Rancho, NM 87124-1519 |
Second Address | Rio Rancho, NM 87124-1519 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2012 |
Last Update Date | 25/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
08453781 | (05) | NM |