Healthcare Provider Details

I. General information

NPI: 1356239669
Provider Name (Legal Business Name): RIVER ROCK MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 06/25/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 MONTGOMERY BLVD NE STE 4B
ALBUQUERQUE NM
87109-1519
US

IV. Provider business mailing address

PO BOX 67792
ALBUQUERQUE NM
87193-7792
US

V. Phone/Fax

Practice location:
  • Phone: 505-400-8396
  • Fax:
Mailing address:
  • Phone: 505-400-8396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: STEFANIE MANZANARES
Title or Position: PRESIDENT/ FNP
Credential: FNP-C
Phone: 505-400-8396