Healthcare Provider Details

I. General information

NPI: 1962348805
Provider Name (Legal Business Name): SONRISA RACHEL MEDINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 STATE HWY 150 UNIT 2
EL PRADO NM
87529
US

IV. Provider business mailing address

38 ADELMO MEDINA DR.
RANCHOS DE TAOS NM
87557
US

V. Phone/Fax

Practice location:
  • Phone: 505-225-3020
  • Fax: 505-212-5265
Mailing address:
  • Phone: 505-225-3020
  • Fax: 505-212-5265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: