Organization
DESERT BLOOM HEALTH COLLABORATIVE LLC
Active
Other names
Desert Bloom Health Collaborative
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHASHWAT PANDHI MD (OWNER)
(505) 542-4970
Entity
Organization
Contact information
Practice address
6121 INDIAN SCHOOL RD NE STE 143, ALBUQUERQUE, NM 87110-3176
(413) 726-4799
(505) 213-6301
Mailing address
6121 INDIAN SCHOOL RD NE STE 143, ALBUQUERQUE, NM 87110-3176
(505) 542-4970
(505) 213-6301
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
103TA0700X
Adult Development & Aging Psychologist
—
—
103TC0700X
Clinical Psychologist
—
—
103TC1900X
Counseling Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
207Q00000X
Family Medicine Physician
—
—
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
—
—
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
2084P0805X
Geriatric Psychiatry Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
76487326
—
NM
Enumeration date
04/29/2024
Last updated
10/06/2024
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