MEDICARE: BACHIR DEBBA MD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist

General Provider Information

NPI Number	:	1639476591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACHIR DEBBA MD LLC

Provider Business Mailing Address
First Line	:	PO BOX 9
Second Line	:
City	:	MESILLA PARK
State	:	NM
Zip	:	88047-0009
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1505 S DON ROSER DR
Second Line	:	SUITE A
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4596
Country	:	US
Telephone Number	:	575-521-3388
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR/OWNER
Name	:	BACHIR DEBBA
Credential	:
Telephone Number	:	575-521-3388

Provider Enumeration Date	:	02/11/2011
Last Update Date	:	02/11/2011

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