Provider Demographics
NPI:1417005976
Name:ARRIETA, ROSA HILDA (MA)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:HILDA
Last Name:ARRIETA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 WITTWER CT NW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-8438
Mailing Address - Country:US
Mailing Address - Phone:505-620-3428
Mailing Address - Fax:
Practice Address - Street 1:343 MAIN ST NW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-8712
Practice Address - Country:US
Practice Address - Phone:505-866-2440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM265444103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM94759006Medicaid