Provider Demographics
NPI:1295125458
Name:MARRUJO, DARLENE
Entity type:Individual
Prefix:MRS
First Name:DARLENE
Middle Name:
Last Name:MARRUJO
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 1:202 LIZARD RANCH RD
Mailing Address - Street 2:
Mailing Address - City:TULAROSA
Mailing Address - State:NM
Mailing Address - Zip Code:88352
Mailing Address - Country:US
Mailing Address - Phone:575-491-9562
Mailing Address - Fax:
Practice Address - Street 1:1106 W QUAY AVE
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-1826
Practice Address - Country:US
Practice Address - Phone:575-746-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
54462355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant