Healthcare Provider Details

I. General information

NPI: 1043159056
Provider Name (Legal Business Name): DESIRAY ROSE CASAUS PACHECO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8205 SPAIN RD NE
ALBUQUERQUE NM
87109-3179
US

IV. Provider business mailing address

2605 AMALIA RD SW
ALBUQUERQUE NM
87105-4203
US

V. Phone/Fax

Practice location:
  • Phone: 505-445-0770
  • Fax: 505-856-7946
Mailing address:
  • Phone: 210-984-4620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: