Healthcare Provider Details

I. General information

NPI: 1881907632
Provider Name (Legal Business Name): KSG FIRST ASSISTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2010
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4663 DEL NORTE CT
LAS CRUCES NM
88007-6924
US

IV. Provider business mailing address

4663 DEL NORTE CT
LAS CRUCES NM
88007-6924
US

V. Phone/Fax

Practice location:
  • Phone: 575-921-8554
  • Fax:
Mailing address:
  • Phone: 575-921-8554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR58667
License Number StateNM

VIII. Authorized Official

Name: KATHLEEN SUZANNE GARZA
Title or Position: REGISTEREDNURSE FIRST ASSISTANT
Credential: RNFA, MSN
Phone: 575-921-8554