| Destino Bella, Llc. | |
|
755 S Telshor Blvd Ste S102 Las Cruces NM 88011-4688 | |
| (575) 222-4355 | |
| (575) 800-0344 |
| Full Name | Destino Bella, Llc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 755 S Telshor Blvd Ste S102, Las Cruces, New Mexico |
| Authorized Official Name and Position | Anai Munoz (OFFICE MANAGER) |
| Authorized Official Contact | 5752224355 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Destino Bella, Llc. 755 S Telshor Blvd Ste S102 Las Cruces NM 88011-4688 Ph: (575) 222-4355 | Destino Bella, Llc. 755 S Telshor Blvd Ste S102 Las Cruces NM 88011-4688 Ph: (575) 222-4355 |
| NPI Number | 1417578816 |
|---|---|
| Provider Enumeration Date | 04/27/2020 |
| Last Update Date | 08/05/2021 |
| Certification Date | 08/05/2021 |
| Medicare PECOS PAC ID | 9436577970 |
|---|---|
| Medicare Enrollment ID | O20200915001381 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417578816 | NPI | - | NPPES |
| 28909585 | Medicaid | NM | |
| 413154YRND | Other | NM | MEDICARE |
| Provider Name | Lorraine G Sanchez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487048609 PECOS PAC ID: 6507187374 Enrollment ID: I20150604001924 |
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