Provider Demographics
NPI:1215107321
Name:RICHINS, RUSTIN DANIEL
Entity type:Individual
Prefix:
First Name:RUSTIN
Middle Name:DANIEL
Last Name:RICHINS
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 1:6135 PAINTBRUSH RD SW
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030-8079
Mailing Address - Country:US
Mailing Address - Phone:575-543-8318
Mailing Address - Fax:
Practice Address - Street 1:6135 PAINTBRUSH RD SW
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-8079
Practice Address - Country:US
Practice Address - Phone:575-543-8318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-4144235Z00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program