Healthcare Provider Details

I. General information

NPI: 1831709443
Provider Name (Legal Business Name): MONIKA BRITO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONIKA GUTIERREZ

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 06/06/2024
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 LASER RD NE
RIO RANCHO NM
87124-4517
US

IV. Provider business mailing address

500 LASER RD NE
RIO RANCHO NM
87124-4517
US

V. Phone/Fax

Practice location:
  • Phone: 505-962-1242
  • Fax:
Mailing address:
  • Phone: 505-962-1242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberM-11158
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberSWB-2023-0387
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2023-1221
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: