Healthcare Provider Details

I. General information

NPI: 1093136541
Provider Name (Legal Business Name): SHERIF PEDIATRICS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2013
Last Update Date: 12/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5419 N LOVINGTON HWY BLDG # 1, SUITE # 2
HOBBS NM
88240-9100
US

IV. Provider business mailing address

5419 N LOVINGTON HWY BLDG # 1, SUITE # 2
HOBBS NM
88240-9100
US

V. Phone/Fax

Practice location:
  • Phone: 575-392-1503
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number208000000X
License Number StateNM

VIII. Authorized Official

Name: ALI SHERIF
Title or Position: BC PEDIATRICIAN
Credential: MD
Phone: 361-537-5171