Indigo Diagnostics LLC

Key facts

NPI

1043763972

Entity type

Organization (NPI type 2)

Primary specialty

Cognitive & Behavioral Psychologist 103TB0200X

License

350792 (NM)

Legal business name

INDIGO DIAGNOSTICS LLC

Practice address

HC 75 Box 1198
Rutheron, NM 87551-9725

Phone

(505) 699-5315

Fax

(575) 588-0199

NPI assigned

Jul 27, 2016

Organization subpart

No

Authorized official

Name

Mariana Ulibarri Horan, M.D. PH.D NCED NPI 1124708276

Title

Psycho Educational Diagnostician

Phone

(505) 699-5315

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mariana Ulibarri Horan School Psychologist · Rutheron, NM · NPI 1124708276
  NPD (past) Authorized official

National Provider Directory

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 27, 2016.

{
    "created_epoch": "1469577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469577600000",
    "number": "1043763972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "HC 75 BOX 1198",
            "city": "RUTHERON",
            "state": "NM",
            "postal_code": "875519725",
            "telephone_number": "505-699-5315",
            "fax_number": "575-588-0199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HC 75 BOX 1198",
            "city": "RUTHERON",
            "state": "NM",
            "postal_code": "875519725",
            "telephone_number": "505-699-5315",
            "fax_number": "575-588-0199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIGO DIAGNOSTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-27",
        "last_updated": "2016-07-27",
        "status": "A",
        "authorized_official_last_name": "ULIBARRI HORAN",
        "authorized_official_first_name": "MARIANA",
        "authorized_official_title_or_position": "PSYCHO EDUCATIONAL DIAGNOSTICIAN",
        "authorized_official_telephone_number": "505-699-5315",
        "authorized_official_credential": "M.D. PH.D NCED"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "NM",
            "license": "350792",
            "primary": true
        },
        {
            "code": "103TM1800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "NM",
            "license": "350792",
            "primary": false
        },
        {
            "code": "251300000X",
            "taxonomy_group": "",
            "desc": "Local Education Agency (LEA)",
            "state": "NM",
            "license": "350792",
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NM",
            "license": "350792",
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "NM",
            "license": "350792",
            "primary": false
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "NM",
            "license": "350792",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rutheron, NM

• Mariana Ulibarri Horan

All providers in Rutheron, NM · Cognitive & Behavioral Psychologist in New Mexico