Healthcare Provider Details

I. General information

NPI: 1033071824
Provider Name (Legal Business Name): BRIGHTLIGHT SURGICAL ASSISTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4999 DREAM DANCER DR NE
RIO RANCHO NM
87144-0851
US

IV. Provider business mailing address

4999 DREAM DANCER DR NE
RIO RANCHO NM
87144-0851
US

V. Phone/Fax

Practice location:
  • Phone: 505-639-3010
  • Fax: 505-639-3010
Mailing address:
  • Phone: 505-639-3010
  • Fax: 505-639-3010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: ROSEMARY A GAISEY
Title or Position: CERTIGIED SURGICAL FIRST ASSISTANT
Credential:
Phone: 505-639-3010