Healthcare Provider Details

I. General information

NPI: 1649113655
Provider Name (Legal Business Name): MEDITERRA MINDFUL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1634 ALAMEDA BLVD NW
ALBUQUERQUE NM
87114-8807
US

IV. Provider business mailing address

1634 ALAMEDA BLVD NW
ALBUQUERQUE NM
87114-8807
US

V. Phone/Fax

Practice location:
  • Phone: 505-897-4100
  • Fax:
Mailing address:
  • Phone: 505-897-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DAWN MARIE DAVIDE
Title or Position: OWNER
Credential:
Phone: 505-897-4100