Provider Demographics
NPI:1700662483
Name:ABEYTA, TANYA
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:ABEYTA
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:PO BOX 1748
Mailing Address - Street 2:
Mailing Address - City:RANCHOS DE TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87557-1748
Mailing Address - Country:US
Mailing Address - Phone:505-633-0733
Mailing Address - Fax:505-472-8122
Practice Address - Street 1:31 RIM VIEW RD
Practice Address - Street 2:
Practice Address - City:RANCHOS DE TAOS
Practice Address - State:NM
Practice Address - Zip Code:87557
Practice Address - Country:US
Practice Address - Phone:505-633-0733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker