Provider Demographics
NPI:1720788219
Name:FALCON-LINARES, MAURA R
Entity Type:Individual
Prefix:
First Name:MAURA
Middle Name:R
Last Name:FALCON-LINARES
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 1:12928 MARVA PL SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-3838
Mailing Address - Country:US
Mailing Address - Phone:505-850-9051
Mailing Address - Fax:
Practice Address - Street 1:12928 MARVA PL SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-3838
Practice Address - Country:US
Practice Address - Phone:505-850-9051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM507324355106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician