MEDICARE: DESTINO BELLA, LLC.

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	363LF0000X	Family Nurse Practitioner
2	261QP2300X	Primary Care Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	413154YRND	OTHER	NM	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417578816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESTINO BELLA, LLC.

Provider Business Mailing Address
First Line	:	2457 S TELSHOR BLVD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-5049
Country	:	US
Telephone Number	:	575-777-4681
Fax Number	:	575-800-0344

Provider Business Practice Location Address
First Line	:	2457 S TELSHOR BLVD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-5049
Country	:	US
Telephone Number	:	575-777-4681
Fax Number	:	575-800-0344

Authorized Official
Title or Position	:	OWNER
Name	:	LORRAINE GLORIA SANCHEZ
Credential	:
Telephone Number	:	575-777-4681

Provider Enumeration Date	:	04/27/2020
Last Update Date	:	05/09/2026

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Directions to “DESTINO BELLA, LLC. ” Practice Location

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