Provider Demographics
NPI:1396243390
Name:LAS BRISAS ENTERPRISES, LLC
Entity type:Organization
Organization Name:LAS BRISAS ENTERPRISES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHELLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:GALINDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-285-3443
Mailing Address - Street 1:1209 BONITA AVE SUITE A
Mailing Address - Street 2:
Mailing Address - City:GRANTS
Mailing Address - State:NM
Mailing Address - Zip Code:87020
Mailing Address - Country:US
Mailing Address - Phone:505-285-3443
Mailing Address - Fax:505-287-3418
Practice Address - Street 1:1209 BONITA AVE SUITE A
Practice Address - Street 2:
Practice Address - City:GRANTS
Practice Address - State:NM
Practice Address - Zip Code:87020
Practice Address - Country:US
Practice Address - Phone:505-285-3443
Practice Address - Fax:505-287-3418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-25
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1104898840Medicaid
NM1659362333Medicaid