Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | M-08073 | NM |
NPI | 1003049248 |
---|---|
Provider Name | Rudy A Tafoya |
First Address | Albuquerque, NM 87106-4374 |
Second Address | Albuquerque, NM 87102-2612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2009 |
Last Update Date | 17/07/2013 |