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NPI Code Detail

MEDICARE: NAOMI SUAZO NP

MEDICARE: NAOMI SUAZO NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner59109NM

General Provider Information

NPI Number : 1255961603
Entity Type Code : Individual
Provider Name (Legal Business Name) : NAOMI SUAZO NP
Provider Business Mailing Address
First Line : 1322 MISSION NUEVO DR APT B
Second Line :
City : LAS CRUCES
State : NM
Zip : 88011-7156
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2545 S DON ROSER DR
Second Line :
City : LAS CRUCES
State : NM
Zip : 88011-9107
Country : US
Telephone Number : 575-522-7880
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2020
Last Update Date : 01/25/2020

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