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Individual

MR. RAYMOND MAYNES

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
1709 MOON ST NE, ALBUQUERQUE, NM 87112-3935
(505) 271-0329
Mailing address
3131 ADAMS ST APT G83, ALBUQUERQUE, NM 87110
(505) 235-0317

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
302R00000X
Health Maintenance Organization
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1093935959
NM
Enumeration date
01/31/2011
Last updated
01/31/2011
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