Healthcare Provider Details

I. General information

NPI: 1598689184
Provider Name (Legal Business Name): ISABELLA BACA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 PEGGY RD SE STE F
RIO RANCHO NM
87124-1035
US

IV. Provider business mailing address

1012 DESERT PAINTBRUSH LOOP NE
RIO RANCHO NM
87144-2603
US

V. Phone/Fax

Practice location:
  • Phone: 505-892-7605
  • Fax:
Mailing address:
  • Phone: 703-424-8562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: