Provider Demographics
NPI:1972260446
Name:TAFOYA, MONIQUE LANAYA
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:LANAYA
Last Name:TAFOYA
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 1:475 COURTHOUSE RD SE
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-9596
Mailing Address - Country:US
Mailing Address - Phone:505-508-3503
Mailing Address - Fax:505-312-8480
Practice Address - Street 1:475 COURTHOUSE RD SE
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-9596
Practice Address - Country:US
Practice Address - Phone:505-508-3503
Practice Address - Fax:505-312-8480
Is Sole Proprietor?:No
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM516069571106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician