Healthcare Provider Details

I. General information

NPI: 1891245189
Provider Name (Legal Business Name): APRENDAMOS INTERVENTION TEAM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1681 HICKORY LOOP
LAS CRUCES NM
88005-6587
US

IV. Provider business mailing address

301 PERKINS DR STE B
LAS CRUCES NM
88005-3248
US

V. Phone/Fax

Practice location:
  • Phone: 575-526-6682
  • Fax: 575-523-7954
Mailing address:
  • Phone: 575-526-6682
  • Fax: 575-523-7954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNM

VIII. Authorized Official

Name: MRS. MAGGIE PROVENCIO
Title or Position: CFO
Credential: CFO
Phone: 575-526-6682