Healthcare Provider Details

I. General information

NPI: 1760300669
Provider Name (Legal Business Name): SIXPAW CAPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2716 SOUTHERN BLVD SE
RIO RANCHO NM
87124-3741
US

IV. Provider business mailing address

2716 SOUTHERN BLVD SE
RIO RANCHO NM
87124-3741
US

V. Phone/Fax

Practice location:
  • Phone: 505-892-8600
  • Fax:
Mailing address:
  • Phone: 505-892-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: NAZARIO YOUNG-TRUJILLO
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 505-720-7339