MEDICARE: MINDADL

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1689537508
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDADL

Provider Business Mailing Address
First Line	:	11860 VISTA DEL SOL DR STE 132
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-6128
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11860 VISTA DEL SOL DR STE 132
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-6128
Country	:	US
Telephone Number	:	985-288-8793
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	UCHECHI DIBIA
Credential	:
Telephone Number	:	915-345-3579

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/09/2025

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Directions to “MINDADL ” Practice Location

Language	Start Address	Practice Location

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