Organization
SANDIA VISTA PSYCHIATRIC-MENTAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DESIREE R PROVENCIO DNP, CNP, PMHNP-BC (MEMBER/MANAGER)
(505) 225-3110
Entity
Organization
Contact information
Practice address
9384 VALLEY VIEW DR NW STE 400, ALBUQUERQUE, NM 87114-4403
(505) 225-3110
(505) 207-7988
Mailing address
PO BOX 45450, RIO RANCHO, NM 87174-5450
(505) 225-3110
(505) 207-7988
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
08/29/2022
Last updated
11/18/2025
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