Healthcare Provider Details

I. General information

NPI: 1427831171
Provider Name (Legal Business Name): ADRIANA GARCILAZO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

571 WALTON BLVD
LAS CRUCES NM
88001-8449
US

IV. Provider business mailing address

PO BOX 3143
ANTHONY NM
88021-3143
US

V. Phone/Fax

Practice location:
  • Phone: 575-524-3501
  • Fax:
Mailing address:
  • Phone: 575-805-0014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00009975
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: