Provider Demographics
NPI:1215173901
Name:FONTES, RAQUEL F (LMT)
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:F
Last Name:FONTES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 GIRARD BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-1718
Mailing Address - Country:US
Mailing Address - Phone:505-265-3400
Mailing Address - Fax:505-265-3404
Practice Address - Street 1:1719 GIRARD BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-1718
Practice Address - Country:US
Practice Address - Phone:505-265-3400
Practice Address - Fax:505-265-3404
Is Sole Proprietor?:No
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5620225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist