Provider Demographics
NPI:1639518822
Name:SALDIVAR, RYAN M
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:M
Last Name:SALDIVAR
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:RYAN
Other - Middle Name:M
Other - Last Name:SALDIVAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:PO BOX 425
Mailing Address - Street 2:
Mailing Address - City:CERRILLOS
Mailing Address - State:NM
Mailing Address - Zip Code:87010-0425
Mailing Address - Country:US
Mailing Address - Phone:505-489-0598
Mailing Address - Fax:
Practice Address - Street 1:2884 HIGHWAY 14
Practice Address - Street 2:
Practice Address - City:MADRID
Practice Address - State:NM
Practice Address - Zip Code:87010
Practice Address - Country:US
Practice Address - Phone:505-489-0598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM225700000X - MASSAGE225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist