Provider Demographics
NPI:1851196935
Name:ARMIJO, KEISHA SAVANNAH
Entity type:Individual
Prefix:
First Name:KEISHA
Middle Name:SAVANNAH
Last Name:ARMIJO
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 1:214 NEEL AVE
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:NM
Mailing Address - Zip Code:87801-4649
Mailing Address - Country:US
Mailing Address - Phone:575-835-0971
Mailing Address - Fax:575-835-3119
Practice Address - Street 1:214 NEEL AVE
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:NM
Practice Address - Zip Code:87801-4649
Practice Address - Country:US
Practice Address - Phone:575-835-0971
Practice Address - Fax:575-835-3119
Is Sole Proprietor?:No
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMG-1561172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker