Healthcare Provider Details

I. General information

NPI: 1689480667
Provider Name (Legal Business Name): AGAPE ANESTHESIA & PERIOPERATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 S TELSHOR BLVD STE A
LAS CRUCES NM
88011-4748
US

IV. Provider business mailing address

1205 S TELSHOR BLVD
LAS CRUCES NM
88011-4748
US

V. Phone/Fax

Practice location:
  • Phone: 575-222-0127
  • Fax: 575-652-3255
Mailing address:
  • Phone: 575-222-0127
  • Fax: 575-652-3255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JESSE HOLGUIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 575-222-0127