Provider Demographics
NPI:1518598317
Name:NABARRETTE, GUADALUPE VIRGINIA
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:VIRGINIA
Last Name:NABARRETTE
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 1:301 LINDA VISTA LN APT 24
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-5149
Mailing Address - Country:US
Mailing Address - Phone:575-758-2596
Mailing Address - Fax:575-758-2596
Practice Address - Street 1:301 LINDA VISTA LN APT 24
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-5149
Practice Address - Country:US
Practice Address - Phone:575-758-2596
Practice Address - Fax:575-758-2596
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)