Healthcare Provider Details

I. General information

NPI: 1992041289
Provider Name (Legal Business Name): PATRICK CHAMBON BRICHTA NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2012
Last Update Date: 12/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7201 FAIRBANKS DR NE
RIO RANCHO NM
87144-5395
US

IV. Provider business mailing address

7201 FAIRBANKS DR NE
RIO RANCHO NM
87144-5395
US

V. Phone/Fax

Practice location:
  • Phone: 505-577-3638
  • Fax:
Mailing address:
  • Phone: 505-577-3638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-02089
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: