Healthcare Provider Details

I. General information

NPI: 1134077050
Provider Name (Legal Business Name): AMADOR HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 W AMADOR AVE
LAS CRUCES NM
88005-2739
US

IV. Provider business mailing address

999 W AMADOR AVE
LAS CRUCES NM
88005-2739
US

V. Phone/Fax

Practice location:
  • Phone: 575-556-9681
  • Fax: 575-652-3785
Mailing address:
  • Phone: 575-556-9681
  • Fax: 575-652-3785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: JESSICA C RAEL
Title or Position: COMMUNITY HEALTH WORKER
Credential:
Phone: 575-556-9681