Provider Demographics
NPI:1841242336
Name:ARGUELLO, TRINIDAD DE JESUS (RN, LISW, PHD)
Entity Type:Individual
Prefix:MRS
First Name:TRINIDAD
Middle Name:DE JESUS
Last Name:ARGUELLO
Suffix:
Gender:F
Credentials:RN, LISW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:ARROYO SECO
Mailing Address - State:NM
Mailing Address - Zip Code:87514-0277
Mailing Address - Country:US
Mailing Address - Phone:575-776-2752
Mailing Address - Fax:575-758-2832
Practice Address - Street 1:413 SIPAPU ROAD
Practice Address - Street 2:BOX 6952
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6489
Practice Address - Country:US
Practice Address - Phone:575-758-5857
Practice Address - Fax:575-758-2832
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-27321041C0700X
NMR12314163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMH6196Medicaid
NMMHC51409Medicaid
343511902Medicare ID - Type Unspecified