Provider Demographics
NPI:1821349192
Name:VRDIN, HECTOR R JR (RMT)
Entity Type:Individual
Prefix:MR
First Name:HECTOR
Middle Name:R
Last Name:VRDIN
Suffix:JR
Gender:M
Credentials:RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:RATON
Mailing Address - State:NM
Mailing Address - Zip Code:87740-3834
Mailing Address - Country:US
Mailing Address - Phone:505-400-6200
Mailing Address - Fax:
Practice Address - Street 1:211 PARK AVE
Practice Address - Street 2:
Practice Address - City:RATON
Practice Address - State:NM
Practice Address - Zip Code:87740-3834
Practice Address - Country:US
Practice Address - Phone:505-400-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013946225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist