Healthcare Provider Details

I. General information

NPI: 1720018468
Provider Name (Legal Business Name): LAS CRUCES DERMATOLOGY ASSOCIATES P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4351 E LOHMAN AVE STE. 208
LAS CRUCES NM
88011-8259
US

IV. Provider business mailing address

4351 E LOHMAN AVE STE. 208
LAS CRUCES NM
88011-8259
US

V. Phone/Fax

Practice location:
  • Phone: 575-521-7117
  • Fax: 575-521-7226
Mailing address:
  • Phone: 575-521-7117
  • Fax: 575-521-7226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number97-332
License Number StateNM

VIII. Authorized Official

Name: DR. ANDREW LUKE ONDO
Title or Position: OWNER
Credential: MD
Phone: 575-521-7117