Healthcare Provider Details

I. General information

NPI: 1780538157
Provider Name (Legal Business Name): BRIANA FUENTES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 LAS MARIAS DR SE
RIO RANCHO NM
87124-1269
US

IV. Provider business mailing address

612 LAS MARIAS DR SE
RIO RANCHO NM
87124-1269
US

V. Phone/Fax

Practice location:
  • Phone: 718-215-5311
  • Fax:
Mailing address:
  • Phone: 718-215-5311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number510845617
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: