Provider Demographics
NPI:1538645833
Name:BACHICHA, CHARLENE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:
Last Name:BACHICHA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7513 LOS LUNAS DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4927
Mailing Address - Country:US
Mailing Address - Phone:505-504-2355
Mailing Address - Fax:
Practice Address - Street 1:7513 LOS LUNAS DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4927
Practice Address - Country:US
Practice Address - Phone:505-504-2355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM7104225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist