Healthcare Provider Details

I. General information

NPI: 1912461252
Provider Name (Legal Business Name): LAURA ANGEL BEJARANO RMTI, LMMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2019
Last Update Date: 01/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 WINDMILL DR
LAS CRUCES NM
88011-8042
US

IV. Provider business mailing address

701 WINDMILL DR
LAS CRUCES NM
88011-8042
US

V. Phone/Fax

Practice location:
  • Phone: 575-312-4555
  • Fax:
Mailing address:
  • Phone: 575-312-4555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberMT8626
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMT8626
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberMT8626
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT8626
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: