Healthcare Provider Details

I. General information

NPI: 1124985239
Provider Name (Legal Business Name): KIERA NICOLE PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 GRANDE BLVD SE STE B5
RIO RANCHO NM
87124-1799
US

IV. Provider business mailing address

1773 TIERRA DEL NORTE LOOP
RIO RANCHO NM
87144-1497
US

V. Phone/Fax

Practice location:
  • Phone: 505-336-0238
  • Fax:
Mailing address:
  • Phone: 505-336-0238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2025-1329
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: