Healthcare Provider Details

I. General information

NPI: 1639476591
Provider Name (Legal Business Name): BACHIR DEBBA MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2011
Last Update Date: 02/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 S DON ROSER DR SUITE A
LAS CRUCES NM
88011-4596
US

IV. Provider business mailing address

PO BOX 9
MESILLA PARK NM
88047-0009
US

V. Phone/Fax

Practice location:
  • Phone: 575-521-3388
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: BACHIR DEBBA
Title or Position: MEDICAL DIRECTOR/OWNER
Credential:
Phone: 575-521-3388