Healthcare Provider Details

I. General information

NPI: 1235052796
Provider Name (Legal Business Name): HEATHER JUAREZ ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 W DELGADO AVE
BELEN NM
87002-2805
US

IV. Provider business mailing address

113 EL MUNDO RD
RIO COMMUNITIES NM
87002-7006
US

V. Phone/Fax

Practice location:
  • Phone: 505-238-7269
  • Fax:
Mailing address:
  • Phone: 505-238-7269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT747
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: