Healthcare Provider Details

I. General information

NPI: 1013839299
Provider Name (Legal Business Name): BRITTANY JEWEL MARES CPSW/CCSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13139 CENTRAL AVE NE
ALBUQUERQUE NM
87123-3031
US

IV. Provider business mailing address

8352 BRONTE LN NW
ALBUQUERQUE NM
87120-8037
US

V. Phone/Fax

Practice location:
  • Phone: 505-460-9574
  • Fax:
Mailing address:
  • Phone: 505-639-0060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: