Healthcare Provider Details

I. General information

NPI: 1346515475
Provider Name (Legal Business Name): MS. MARGO G BENCOMO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 03/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 VALVERDE LOOP
LAS CRUCES NM
88012-8550
US

IV. Provider business mailing address

3325 VALVERDE LOOP
LAS CRUCES NM
88012-8550
US

V. Phone/Fax

Practice location:
  • Phone: 575-525-2337
  • Fax: 575-525-2337
Mailing address:
  • Phone: 575-525-2337
  • Fax: 575-525-2337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number008272158
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: