Provider Demographics
NPI:1639644636
Name:TAFOYA, VINCENT XAVIER JR
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:XAVIER
Last Name:TAFOYA
Suffix:JR
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 1:1808 W ALAMEDA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1711
Mailing Address - Country:US
Mailing Address - Phone:505-377-7393
Mailing Address - Fax:
Practice Address - Street 1:4001 OFFICE COURT DR STE 706
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4958
Practice Address - Country:US
Practice Address - Phone:505-395-9611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst