Provider Demographics
NPI:1487204517
Name:SILVA, MAX RALPH
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:RALPH
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 1:549 CORONADO DR
Mailing Address - Street 2:
Mailing Address - City:BERNALILLO
Mailing Address - State:NM
Mailing Address - Zip Code:87004-9103
Mailing Address - Country:US
Mailing Address - Phone:505-270-8677
Mailing Address - Fax:
Practice Address - Street 1:201 VILLA ELENA LN
Practice Address - Street 2:
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004-5935
Practice Address - Country:US
Practice Address - Phone:505-270-8677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider