Individual
TY RIED
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
400 GOLD AVE. SE, SUITE 1300 WEST, ALBUQUERQUE, NM 87102
(505) 715-4610
(505) 715-4620
Mailing address
8205 SPAIN RD NE STE 106, ALBUQUERQUE, NM 87109-3155
(505) 856-0300
(505) 856-7946
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
05/31/2022
Last updated
12/04/2023
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