Healthcare Provider Details

I. General information

NPI: 1710025648
Provider Name (Legal Business Name): KIRSTEN LAVISTA DN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 CERRILLOS RD SUITE 407
SANTA FE NM
87507-2612
US

IV. Provider business mailing address

2006 BOTULPH RD STE A
SANTA FE NM
87505-5764
US

V. Phone/Fax

Practice location:
  • Phone: 505-424-8990
  • Fax: 505-424-6377
Mailing address:
  • Phone: 505-424-8990
  • Fax: 505-424-6377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172P00000X
TaxonomyNaprapath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: