Healthcare Provider Details

I. General information

NPI: 1508129727
Provider Name (Legal Business Name): FARES HASHEM YASIN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 CENTER AVE UNIT A
CARLSBAD NM
88220-6106
US

IV. Provider business mailing address

506E CENTER AVENUE UNIT A
CARLSBAD NM
88220
US

V. Phone/Fax

Practice location:
  • Phone: 575-414-8055
  • Fax: 575-215-3148
Mailing address:
  • Phone: 575-396-6611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD459482
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2020-0002
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: