Provider Demographics
NPI:1912530452
Name:ANAYA, RAYMOND A
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:A
Last Name:ANAYA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 S SADDLER ST
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030-6146
Mailing Address - Country:US
Mailing Address - Phone:575-649-7656
Mailing Address - Fax:
Practice Address - Street 1:2011 S SADDLER ST
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-6146
Practice Address - Country:US
Practice Address - Phone:575-649-7656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician