Healthcare Provider Details

I. General information

NPI: 1023894607
Provider Name (Legal Business Name): FRONTERA HEALTH NEW MEXICO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 HILLRISE CIR
LAS CRUCES NM
88011-4741
US

IV. Provider business mailing address

1250 HILLRISE CIR
LAS CRUCES NM
88011-4741
US

V. Phone/Fax

Practice location:
  • Phone: 575-288-1881
  • Fax: 575-288-1889
Mailing address:
  • Phone: 575-288-1881
  • Fax: 575-288-1889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: AMOL DESHPANDE
Title or Position: CEO
Credential:
Phone: 650-804-4440