Healthcare Provider Details

I. General information

NPI: 1053247528
Provider Name (Legal Business Name): YUCA VIDA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 S 8TH ST
DEMING NM
88030-4903
US

IV. Provider business mailing address

1403 S MESILLA ST
DEMING NM
88030-4944
US

V. Phone/Fax

Practice location:
  • Phone: 575-332-1312
  • Fax:
Mailing address:
  • Phone: 575-332-1312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LIDIA VEGA CHAVIRA
Title or Position: CEO
Credential: LADAC, LMSW, CPSW
Phone: 575-332-1312