Healthcare Provider Details

I. General information

NPI: 1174809586
Provider Name (Legal Business Name): ANITA CARMEN RETA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2011
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 ANTHONY DR
ANTHONY NM
88021-9325
US

IV. Provider business mailing address

385 CALLE DE ALEGRA BLDG A
LAS CRUCES NM
88005-3423
US

V. Phone/Fax

Practice location:
  • Phone: 575-201-5135
  • Fax: 575-449-4052
Mailing address:
  • Phone: 575-526-1105
  • Fax: 575-524-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125078663
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2026-0645
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberLT23248
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: