Provider Demographics
NPI:1225471154
Name:JUAREZ, CLARISSA C (CNP)
Entity Type:Individual
Prefix:MS
First Name:CLARISSA
Middle Name:C
Last Name:JUAREZ
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3231 CAMINITO SAN LUCAS
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-0443
Mailing Address - Country:US
Mailing Address - Phone:505-535-3033
Mailing Address - Fax:505-570-5501
Practice Address - Street 1:3231 CAMINITO SAN LUCAS
Practice Address - Street 2:DBA RIO DE LA VIDA MEDSPA, LLC.
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507
Practice Address - Country:US
Practice Address - Phone:207-756-3073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-158552363LP0808X
NMCNP-02161364SP0808X, 363LP0808X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult