Healthcare Provider Details

I. General information

NPI: 1821448879
Provider Name (Legal Business Name): GIOVANNA MUSITANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 06/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 E LOHMAN AVE STE 223
LAS CRUCES NM
88001-3172
US

IV. Provider business mailing address

1990 E LOHMAN AVE STE 223
LAS CRUCES NM
88001-3172
US

V. Phone/Fax

Practice location:
  • Phone: 575-993-5720
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberX-09603
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: