Healthcare Provider Details

I. General information

NPI: 1962106815
Provider Name (Legal Business Name): CHRISTIAN BRITO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 MCNUTT RD
SANTA TERESA NM
88008-9621
US

IV. Provider business mailing address

2002 SUDDERTH DR
RUIDOSO NM
88345-6119
US

V. Phone/Fax

Practice location:
  • Phone: 575-882-6200
  • Fax:
Mailing address:
  • Phone: 575-257-2368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number415724
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberSWB-2022-0985
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: