Provider Demographics
NPI:1790574226
Name:SOUTHWEST MEDICAL MASSAGE LLC
Entity type:Organization
Organization Name:SOUTHWEST MEDICAL MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:BACHICHA
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:505-504-2355
Mailing Address - Street 1:6711 MESA MARIPOSA PL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-3357
Mailing Address - Country:US
Mailing Address - Phone:505-504-2355
Mailing Address - Fax:
Practice Address - Street 1:6711 MESA MARIPOSA PL NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-3357
Practice Address - Country:US
Practice Address - Phone:505-504-2355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty