Healthcare Provider Details

I. General information

NPI: 1982250312
Provider Name (Legal Business Name): SETH DAIGLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3375 RINCONADA BLVD
LAS CRUCES NM
88011
US

IV. Provider business mailing address

2229 DAKOTA DR APT 3
LAS CRUCES NM
88011-8109
US

V. Phone/Fax

Practice location:
  • Phone: 225-717-2903
  • Fax:
Mailing address:
  • Phone: 225-717-2903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00009150
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: