Healthcare Provider Details

I. General information

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

II. Dates (important events)

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

III. Provider practice location address

4171 BIG SKY RD
SANTA FE NM
87507-4887
US

IV. Provider business mailing address

4171 BIG SKY RD
SANTA FE NM
87507-4887
US

V. Phone/Fax

Practice location:
  • Phone: 505-490-2558
  • Fax:
Mailing address:
  • Phone: 505-490-2558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberRN-87543
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: