Healthcare Provider Details

I. General information

NPI: 1083427611
Provider Name (Legal Business Name): BIPOC AND SEXUALITY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4915 BERYL ST
LAS CRUCES NM
88012-9425
US

IV. Provider business mailing address

PO BOX 1254
HATCH NM
87937-1254
US

V. Phone/Fax

Practice location:
  • Phone: 575-312-2705
  • Fax:
Mailing address:
  • Phone: 575-312-2705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. SANDRA YEZENIA GUTIERREZ
Title or Position: FOUNDER/CEO
Credential: EDD, PHD, LCSW
Phone: 575-312-2705