Healthcare Provider Details

I. General information

NPI: 1639095938
Provider Name (Legal Business Name): HEALTH BRIDGE2GOAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4105 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87109-1102
US

IV. Provider business mailing address

1209 MOUNTAIN ROAD PL NE STE N
ALBUQUERQUE NM
87110-7825
US

V. Phone/Fax

Practice location:
  • Phone: 407-990-3828
  • Fax:
Mailing address:
  • Phone: 407-990-3828
  • 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: ANTONIO BRICENO PARRA
Title or Position: MANAGING MEMBER
Credential: FNP-C
Phone: 407-990-3828