Healthcare Provider Details

I. General information

NPI: 1669004073
Provider Name (Legal Business Name): NUEVO DIA BEHAVIORAL HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1570 W PICACHO AVE STE 2
LAS CRUCES NM
88005-2375
US

IV. Provider business mailing address

2007 TURRENTINE DR
LAS CRUCES NM
88005-3344
US

V. Phone/Fax

Practice location:
  • Phone: 575-571-9076
  • Fax:
Mailing address:
  • Phone: 575-386-3234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. FERNANDO JAVIER GUILLEN I
Title or Position: NURSE PRACTITIONER
Credential: PMHNP-BC
Phone: 575-571-9076