Healthcare Provider Details

I. General information

NPI: 1083290480
Provider Name (Legal Business Name): BEBA MILAGROS PEREZ-RODRIGUEZ PSY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 W 21ST ST STE B
CLOVIS NM
88101-2006
US

IV. Provider business mailing address

224 W D. L. INGRAM AVENUE, BLDG. 1408
CANNON AFB NM
88103
US

V. Phone/Fax

Practice location:
  • Phone: 575-742-7833
  • Fax: 575-742-7856
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-2024-0095
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2021004982
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: