Healthcare Provider Details

I. General information

NPI: 1619833415
Provider Name (Legal Business Name): RAHMA COBURN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2025
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1691 GALISTEO ST STE D
SANTA FE NM
87505-4781
US

IV. Provider business mailing address

PO BOX 6880
SANTA FE NM
87502-6880
US

V. Phone/Fax

Practice location:
  • Phone: 505-922-9121
  • Fax: 505-982-0279
Mailing address:
  • Phone: 505-955-9454
  • Fax: 505-216-0332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberRN-87543
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number87380
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: