Provider Demographics
NPI:1114689189
Name:PAIN, BEATRIZ G
Entity Type:Individual
Prefix:MS
First Name:BEATRIZ
Middle Name:G
Last Name:PAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 32 BOX 706
Mailing Address - Street 2:
Mailing Address - City:QUEMADO
Mailing Address - State:NM
Mailing Address - Zip Code:87829-9613
Mailing Address - Country:US
Mailing Address - Phone:520-820-3574
Mailing Address - Fax:
Practice Address - Street 1:22 HOPI DR
Practice Address - Street 2:
Practice Address - City:QUEMADO
Practice Address - State:NM
Practice Address - Zip Code:87829-9131
Practice Address - Country:US
Practice Address - Phone:520-820-3545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider