Provider Demographics
NPI:1538037502
Name:NORIEGA, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:NORIEGA
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 1:601 W COUNTRY CLUB RD STE 102
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-5227
Mailing Address - Country:US
Mailing Address - Phone:505-601-6081
Mailing Address - Fax:505-925-0085
Practice Address - Street 1:601 W COUNTRY CLUB RD STE 102
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5227
Practice Address - Country:US
Practice Address - Phone:505-601-6081
Practice Address - Fax:505-925-0085
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-29
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator