MEDICARE: BALERIA SANTISTEVAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1063708964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BALERIA SANTISTEVAN

Provider Business Mailing Address
First Line	:	PO BOX 28220
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87592-8220
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 BERTHA RD STE B
Second Line	:
City	:	TAOS
State	:	NM
Zip	:	87571-7148
Country	:	US
Telephone Number	:	575-758-4297
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2011
Last Update Date	:	11/14/2023

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Directions to “ BALERIA SANTISTEVAN ” Practice Location

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