Healthcare Provider Details

I. General information

NPI: 1912900259
Provider Name (Legal Business Name): ALLERGY & ASTHMA CENTER OF THE SOUTHWEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 05/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 MALL DR STE B
LAS CRUCES NM
88011-8194
US

IV. Provider business mailing address

1141 MALL DR STE A-B
LAS CRUCES NM
88011-8194
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-2400
  • Fax: 575-522-2375
Mailing address:
  • Phone: 575-522-2400
  • Fax: 575-522-2375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number83-322
License Number StateNM

VIII. Authorized Official

Name: DR. STANISLAUS TING
Title or Position: PHYSICIAN
Credential: M.D,
Phone: 505-522-2400