Healthcare Provider Details

I. General information

NPI: 1609797778
Provider Name (Legal Business Name): KRYSTAL ANN DEBONIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 RIO GRANDE BLVD NW STE H160
ALBUQUERQUE NM
87104-2063
US

IV. Provider business mailing address

420 PASEO DE CORRALES
CORRALES NM
87048-9575
US

V. Phone/Fax

Practice location:
  • Phone: 505-278-0807
  • Fax:
Mailing address:
  • Phone: 505-559-0535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: