Healthcare Provider Details

I. General information

NPI: 1053252007
Provider Name (Legal Business Name): ARYSLEIDA BARRAZA-GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 03/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 MAIN ST NW STE M
LOS LUNAS NM
87031-4866
US

IV. Provider business mailing address

1812 VALLE VISTA RD NW
LOS LUNAS NM
87031-8189
US

V. Phone/Fax

Practice location:
  • Phone: 505-916-0533
  • Fax:
Mailing address:
  • Phone: 330-316-8804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2026019063
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: