Healthcare Provider Details

I. General information

NPI: 1639726920
Provider Name (Legal Business Name): RIBERA HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 ENCINO PL. NE SUITE D-7
ALBUQUERQUE NM
87102-2644
US

IV. Provider business mailing address

801 ENCINO PL NE STE D7
ALBUQUERQUE NM
87102-2644
US

V. Phone/Fax

Practice location:
  • Phone: 505-207-6526
  • Fax: 505-212-1615
Mailing address:
  • Phone: 505-207-6526
  • Fax: 505-212-1615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: OLGA LUCERO
Title or Position: PRESIDENT
Credential: CNP
Phone: 505-450-4478