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NPI Code Detail

MEDICARE: BRISA BANDA

MEDICARE: BRISA BANDA
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
1106S00000XBehavior TechnicianNM

General Provider Information

NPI Number : 1710611991
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRISA BANDA
Provider Business Mailing Address
First Line : 3876 HAWKINS ST NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87109-4539
Country : US
Telephone Number : 505-508-0865
Fax Number :
Provider Business Practice Location Address
First Line : 1201 PARKWAY DR
Second Line :
City : SANTA FE
State : NM
Zip : 87507-7258
Country : US
Telephone Number : 505-508-0865
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2022
Last Update Date : 07/13/2022

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Directions to “ BRISA BANDA ” Practice Location

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