Healthcare Provider Details

I. General information

NPI: 1063150498
Provider Name (Legal Business Name): BUEN CAMINO PSYCHIATRIC & MENTAL HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 BOSQUE FARMS BLVD
BOSQUE FARMS NM
87068-8957
US

IV. Provider business mailing address

1415 BOSQUE FARMS BLVD
BOSQUE FARMS NM
87068-8957
US

V. Phone/Fax

Practice location:
  • Phone: 505-475-6677
  • Fax:
Mailing address:
  • Phone: 505-475-6677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. CLAUDIA G CRUZ
Title or Position: NURSE PRACTITIONER
Credential: DNP, PMHNP-BC
Phone: 505-475-6677