Provider Demographics
NPI:1912672601
Name:RICE, MARINA (CPSW)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:RICE
Suffix:
Gender:F
Credentials:CPSW
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 227
Mailing Address - Street 2:
Mailing Address - City:MESCALERO
Mailing Address - State:NM
Mailing Address - Zip Code:88340-0227
Mailing Address - Country:US
Mailing Address - Phone:575-464-4432
Mailing Address - Fax:575-464-4331
Practice Address - Street 1:107 SUNSET LOOP
Practice Address - Street 2:
Practice Address - City:MESCALERO
Practice Address - State:NM
Practice Address - Zip Code:88340-8834
Practice Address - Country:US
Practice Address - Phone:575-464-4432
Practice Address - Fax:575-464-4331
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM833175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist