Provider Demographics
NPI:1073108296
Name:SILVA, JOAQUIN R
Entity Type:Individual
Prefix:
First Name:JOAQUIN
Middle Name:R
Last Name:SILVA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 SUNSET LOOP
Mailing Address - Street 2:
Mailing Address - City:MESCALERO
Mailing Address - State:NM
Mailing Address - Zip Code:88340-0228
Mailing Address - Country:US
Mailing Address - Phone:575-464-4432
Mailing Address - Fax:505-212-0576
Practice Address - Street 1:107 SUNSET LOOP
Practice Address - Street 2:
Practice Address - City:MESCALERO
Practice Address - State:NM
Practice Address - Zip Code:88340-0228
Practice Address - Country:US
Practice Address - Phone:575-464-4432
Practice Address - Fax:505-212-0576
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCSA0201701101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health