Provider Demographics
NPI:1346950011
Name:CONCHO, ERLINDA M
Entity Type:Individual
Prefix:
First Name:ERLINDA
Middle Name:M
Last Name:CONCHO
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:PO BOX 256
Mailing Address - Street 2:
Mailing Address - City:PUEBLO OF ACOMA
Mailing Address - State:NM
Mailing Address - Zip Code:87034-0256
Mailing Address - Country:US
Mailing Address - Phone:505-552-5145
Mailing Address - Fax:
Practice Address - Street 1:27 PINSBARRI RD
Practice Address - Street 2:
Practice Address - City:PUEBLO OF ACOMA
Practice Address - State:NM
Practice Address - Zip Code:87034-0256
Practice Address - Country:US
Practice Address - Phone:505-552-5145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM172V00000XMedicaid