Basic Information
| Provider Information | |||||||||
| NPI: | 1730856832 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BIAS | ||||||||
| FirstName: | ROSA | ||||||||
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| Credential: | CPSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6367 SANDPIPER TRL NE | ||||||||
| Address2: | |||||||||
| City: | RIO RANCHO | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871445132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5055823433 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 912 1ST ST NW | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871022355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052249777 | ||||||||
| FaxNumber: | 5052249779 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2021 | ||||||||
| LastUpdateDate: | 08/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 175T00000X | NM | Y |
No ID Information.