Healthcare Provider Details

I. General information

NPI: 1356081392
Provider Name (Legal Business Name): ANGELA JOY AVENT LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELA JOY HORTON

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 ROSEDALE DR
LAS CRUCES NM
88005-1448
US

IV. Provider business mailing address

2380 ROSEDALE DR
LAS CRUCES NM
88005-1448
US

V. Phone/Fax

Practice location:
  • Phone: 505-352-4830
  • Fax:
Mailing address:
  • Phone: 505-352-4830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number22002R
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: