Enchantment Healthcare,LLC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA2005-0037 Issued in NM

Legal business name

ENCHANTMENT HEALTHCARE,LLC

Practice address

106 Main St NE
Suite a
Los Lunas, NM 87031-7559

Phone

(505) 565-0070

Fax

(505) 565-0978

NPI assigned

May 30, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Monique Nicole Sisneros

Title

Office Manager

Phone

(505) 615-8336

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1369872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369872000000",
    "number": "1962849950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 MAIN ST NE",
            "address_2": "SUITE A",
            "city": "LOS LUNAS",
            "state": "NM",
            "postal_code": "870317559",
            "telephone_number": "505-565-0070",
            "fax_number": "505-565-0978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 MAIN ST NE",
            "address_2": "SUITE A",
            "city": "LOS LUNAS",
            "state": "NM",
            "postal_code": "870317559",
            "telephone_number": "505-565-0070",
            "fax_number": "505-565-0978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENCHANTMENT HEALTHCARE,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-30",
        "last_updated": "2013-05-30",
        "status": "A",
        "authorized_official_last_name": "SISNEROS",
        "authorized_official_first_name": "MONIQUE",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "505-615-8336",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "NM",
            "license": "84-288",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "NM",
            "license": "PA2005-0037",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Los Lunas, NM
• Providers in Los Lunas, NM by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.