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General NPI Number Information
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NPI Number | 1962849950
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Entity Type | Organization
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Legal Business Name | ENCHANTMENT HEALTHCARE,LLC
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Dates
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Enumeration Date | 05/30/2013
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Last Update Date | 05/30/2013
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Provider Practice Location Address
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Address Line | 106 MAIN ST NE SUITE A
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City | LOS LUNAS
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State | NM
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Zip | 87031-7559
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Country | US
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Telephone | 505-565-0070
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Fax | 505-565-0978
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Provider Business Mailing Address
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Address Line | 106 MAIN ST NE SUITE A
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City | LOS LUNAS
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State | NM
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Zip | 87031-7559
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Country | US
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Telephone | 505-565-0070
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Fax | 505-565-0978
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MONIQUE NICOLE SISNEROS
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Credential |
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Telephone | 505-615-8336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 84-288
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2005-0037
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License Number State | NM
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