Healthcare Provider Details

I. General information

NPI: 1275909152
Provider Name (Legal Business Name): MONA TALEBREZA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2015
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date: 03/04/2026
Reactivation Date: 03/17/2026

III. Provider practice location address

455 SAINT MICHAELS DR
SANTA FE NM
87505-7601
US

IV. Provider business mailing address

455 SAINT MICHAELS DR
SANTA FE NM
87505-7601
US

V. Phone/Fax

Practice location:
  • Phone: 505-819-7669
  • Fax:
Mailing address:
  • Phone: 505-819-7669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number56447
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: