Provider Demographics
NPI:1962213520
Name:JARAMILLO, ANTHONY E
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:E
Last Name:JARAMILLO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 BLANCHARD ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-3320
Mailing Address - Country:US
Mailing Address - Phone:505-398-6270
Mailing Address - Fax:
Practice Address - Street 1:500 BLANCHARD ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-3320
Practice Address - Country:US
Practice Address - Phone:505-398-6270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-14
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver