Provider Demographics
NPI:1891312922
Name:LUERA CSW, ERNESTINA RODRIGUEZ
Entity type:Individual
Prefix:MRS
First Name:ERNESTINA
Middle Name:RODRIGUEZ
Last Name:LUERA CSW
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 2267
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87504-2267
Mailing Address - Country:US
Mailing Address - Phone:575-546-2174
Mailing Address - Fax:
Practice Address - Street 1:901 W HICKORY ST
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-4046
Practice Address - Country:US
Practice Address - Phone:575-546-2174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-06
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator