Healthcare Provider Details

I. General information

NPI: 1548119811
Provider Name (Legal Business Name): TRAVIS G POPE CPSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2026
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 N MAIN ST STE 1
LAS CRUCES NM
88001-1281
US

IV. Provider business mailing address

324 PAJARO RD
LAS CRUCES NM
88005-3528
US

V. Phone/Fax

Practice location:
  • Phone: 575-300-4450
  • Fax:
Mailing address:
  • Phone: 505-430-3688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number2009
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: