Provider Demographics
NPI:1871922815
Name:DILLARD, RAMONA
Entity type:Individual
Prefix:
First Name:RAMONA
Middle Name:
Last Name:DILLARD
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 194
Mailing Address - Street 2:
Mailing Address - City:LAGUNA
Mailing Address - State:NM
Mailing Address - Zip Code:87026-0194
Mailing Address - Country:US
Mailing Address - Phone:505-552-6652
Mailing Address - Fax:505-552-0605
Practice Address - Street 1:3 SAN JOSE
Practice Address - Street 2:
Practice Address - City:LAGUNA
Practice Address - State:NM
Practice Address - Zip Code:87026-5026
Practice Address - Country:US
Practice Address - Phone:505-552-6652
Practice Address - Fax:505-552-0605
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 174H00000X
NMR19339163W00000X
NM172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No163W00000XNursing Service ProvidersRegistered Nurse
No174H00000XOther Service ProvidersHealth Educator