Healthcare Provider Details

I. General information

NPI: 1881537629
Provider Name (Legal Business Name): BIANCA L BAEZA-HOLGUIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S DIAMOND AVE
DEMING NM
88030-4710
US

IV. Provider business mailing address

1001 S DIAMOND AVE
DEMING NM
88030-4710
US

V. Phone/Fax

Practice location:
  • Phone: 575-546-8841
  • Fax: 575-546-8517
Mailing address:
  • Phone: 575-546-8841
  • Fax: 575-546-8517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSAH-2025-0300
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: