Healthcare Provider Details

I. General information

NPI: 1639715683
Provider Name (Legal Business Name): YANIRA Y SOLIS ACOSTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 PERKINS DR STE B
LAS CRUCES NM
88005-3248
US

IV. Provider business mailing address

301 PERKINS DR STE B
LAS CRUCES NM
88005-3248
US

V. Phone/Fax

Practice location:
  • Phone: 575-526-6682
  • Fax: 575-523-7254
Mailing address:
  • Phone: 575-526-6682
  • Fax: 575-523-7254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: