Healthcare Provider Details

I. General information

NPI: 1356641203
Provider Name (Legal Business Name): EL PUEBLO HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 CALLE DEL PRESIDENTE
BERNALILLO NM
87004-6091
US

IV. Provider business mailing address

121 CALLE DEL PRESIDENTE
BERNALILLO NM
87004-6091
US

V. Phone/Fax

Practice location:
  • Phone: 505-867-2324
  • Fax:
Mailing address:
  • Phone: 505-867-2324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP01683
License Number StateNM

VIII. Authorized Official

Name: MRS. TAMARA L RIGHETTINI
Title or Position: CERTIFIED NURSE PRACTITIONER
Credential: CFNP
Phone: 505-867-2324