Provider Demographics
NPI:1356641203
Name:EL PUEBLO HEALTHCARE
Entity type:Organization
Organization Name:EL PUEBLO HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:RIGHETTINI
Authorized Official - Suffix:
Authorized Official - Credentials:CFNP
Authorized Official - Phone:505-867-2324
Mailing Address - Street 1:121 CALLE DEL PRESIDENTE
Mailing Address - Street 2:
Mailing Address - City:BERNALILLO
Mailing Address - State:NM
Mailing Address - Zip Code:87004-6091
Mailing Address - Country:US
Mailing Address - Phone:505-867-2324
Mailing Address - Fax:
Practice Address - Street 1:121 CALLE DEL PRESIDENTE
Practice Address - Street 2:
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004-6091
Practice Address - Country:US
Practice Address - Phone:505-867-2324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP01683363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty