Healthcare Provider Details

I. General information

NPI: 1598535510
Provider Name (Legal Business Name): QUERENCIA NM LCC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 CERRO DE ORTEGA DR SE
RIO RANCHO NM
87124-1102
US

IV. Provider business mailing address

214 CERRO DE ORTEGA DR SE
RIO RANCHO NM
87124-1102
US

V. Phone/Fax

Practice location:
  • Phone: 505-525-7624
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: RACHEL BAEZA
Title or Position: OWNER
Credential: LCSW
Phone: 505-525-7624