Healthcare Provider Details

I. General information

NPI: 1396243390
Provider Name (Legal Business Name): LAS BRISAS ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 BONITA AVE SUITE A
GRANTS NM
87020
US

IV. Provider business mailing address

1209 BONITA AVE SUITE A
GRANTS NM
87020
US

V. Phone/Fax

Practice location:
  • Phone: 505-285-3443
  • Fax: 505-287-3418
Mailing address:
  • Phone: 505-285-3443
  • Fax: 505-287-3418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. RACHELLE R GALINDO
Title or Position: OFFICE MANAGER
Credential:
Phone: 505-285-3443