Basic Information
| Provider Information | |||||||||
| NPI: | 1639476591 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BACHIR DEBBA MD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9 | ||||||||
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| City: | MESILLA PARK | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880470009 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1505 S DON ROSER DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880114596 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5755213388 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2011 | ||||||||
| LastUpdateDate: | 02/11/2011 | ||||||||
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| AuthorizedOfficialLastName: | DEBBA | ||||||||
| AuthorizedOfficialFirstName: | BACHIR | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5755213388 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Counseling |
No ID Information.