Provider Demographics
NPI:1942025606
Name:QUIMAYOUSIE, MATTHEW R
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:R
Last Name:QUIMAYOUSIE
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 1:3610 BUCKSKIN LOOP NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-1423
Mailing Address - Country:US
Mailing Address - Phone:505-236-6918
Mailing Address - Fax:
Practice Address - Street 1:3610 BUCKSKIN LOOP NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-1423
Practice Address - Country:US
Practice Address - Phone:505-236-6918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician