Healthcare Provider Details

I. General information

NPI: 1477373728
Provider Name (Legal Business Name): CRUZ ORTEGA CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W LEA ST
HOBBS NM
88240-5110
US

IV. Provider business mailing address

200 W LEA ST
HOBBS NM
88240-5110
US

V. Phone/Fax

Practice location:
  • Phone: 575-391-0270
  • Fax: 505-443-8329
Mailing address:
  • Phone: 575-391-0270
  • Fax: 505-443-8329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number82877
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: