Healthcare Provider Details

I. General information

NPI: 1770469272
Provider Name (Legal Business Name): RIO GRANDE MENTAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 COMMONS AVE NE STE A
ALBUQUERQUE NM
87109-5831
US

IV. Provider business mailing address

PO BOX 1072
CASTROVILLE TX
78009-1072
US

V. Phone/Fax

Practice location:
  • Phone: 505-585-5580
  • Fax: 505-585-5583
Mailing address:
  • Phone: 956-371-2007
  • Fax: 956-338-2993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NATHANIEL GERARDO CERVANTES
Title or Position: OWNER/MANAGER
Credential: DNP APRN
Phone: 956-371-2007