Healthcare Provider Details

I. General information

NPI: 1497671580
Provider Name (Legal Business Name): TABITHA FAITH PICHARDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 S SOLANO DR
LAS CRUCES NM
88001-3758
US

IV. Provider business mailing address

999 S TELSHOR BLVD APT 804
LAS CRUCES NM
88011-4651
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-4004
  • Fax:
Mailing address:
  • Phone: 915-929-2221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: