Healthcare Provider Details

I. General information

NPI: 1376402834
Provider Name (Legal Business Name): RAICES HEALING & CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2026
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3123 BRIDGE BLVD SW UNIT B
ALBUQUERQUE NM
87121-3335
US

IV. Provider business mailing address

3123 BRIDGE BLVD SW UNIT B
ALBUQUERQUE NM
87121-3335
US

V. Phone/Fax

Practice location:
  • Phone: 310-722-2630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: BRENDA QUINONEZ-CORTES
Title or Position: OWNER
Credential:
Phone: 310-722-2630