Healthcare Provider Details

I. General information

NPI: 1689136418
Provider Name (Legal Business Name): CESAR'S ROOM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 BROTHERS RD
SANTA FE NM
87505-6913
US

IV. Provider business mailing address

518 OLD SANTA FE TRL STE 1
SANTA FE NM
87505-0398
US

V. Phone/Fax

Practice location:
  • Phone: 505-913-0953
  • Fax:
Mailing address:
  • Phone: 505-913-0953
  • Fax: 505-983-9609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: FRANCESCA LOUISE SHRADY
Title or Position: OWNER
Credential: LPCC
Phone: 505-913-0953