Healthcare Provider Details

I. General information

NPI: 1467303685
Provider Name (Legal Business Name): PICURIS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2026
Last Update Date: 02/04/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 K 2 BUFFALO TRAIL
PENASCO NM
87553
US

IV. Provider business mailing address

201 K 2 BUFFALO TRAIL
PENASCO NM
87553
US

V. Phone/Fax

Practice location:
  • Phone: 575-281-8010
  • Fax: 833-438-5215
Mailing address:
  • Phone: 575-281-8010
  • Fax: 833-438-5215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JESSICA TAYLOR CHACON
Title or Position: CLINICAL PRACTICED MANAGER
Credential:
Phone: 505-927-0918