Healthcare Provider Details

I. General information

NPI: 1679299549
Provider Name (Legal Business Name): MONIQUE ARANCIBIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 CONRAD LN
TAOS NM
87571-6812
US

IV. Provider business mailing address

520 CONRAD LN
TAOS NM
87571-6812
US

V. Phone/Fax

Practice location:
  • Phone: 575-770-8903
  • Fax:
Mailing address:
  • Phone: 575-770-8903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCTB-2023-0855
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: