Healthcare Provider Details

I. General information

NPI: 1184589368
Provider Name (Legal Business Name): MRS. DESIRE M MENCHACA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8650 ALAMEDA BLVD NE STE 101E
ALBUQUERQUE NM
87122-3791
US

IV. Provider business mailing address

9223 BEAVER CREEK RD NW
ALBUQUERQUE NM
87120-6276
US

V. Phone/Fax

Practice location:
  • Phone: 505-255-1866
  • Fax:
Mailing address:
  • Phone: 505-660-2833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number87224
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: