Healthcare Provider Details

I. General information

NPI: 1851908479
Provider Name (Legal Business Name): IZAIAH ALEXANDER INIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 E AMADOR AVE STE 101
LAS CRUCES NM
88001-3675
US

IV. Provider business mailing address

301 PERKINS DR
LAS CRUCES NM
88005-3248
US

V. Phone/Fax

Practice location:
  • Phone: 575-520-6074
  • Fax:
Mailing address:
  • Phone: 575-526-6682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-76654
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: