Healthcare Provider Details

I. General information

NPI: 1528402054
Provider Name (Legal Business Name): MS. LINDA M DEMARINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2013
Last Update Date: 05/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 HWY 195
ELEPHANT BUTTE NM
87935
US

IV. Provider business mailing address

100 W GRIGGS AVE
LAS CRUCES NM
88001
US

V. Phone/Fax

Practice location:
  • Phone: 575-744-4064
  • Fax: 575-744-4066
Mailing address:
  • Phone: 575-647-2800
  • Fax: 575-647-2898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: