Healthcare Provider Details

I. General information

NPI: 1083703250
Provider Name (Legal Business Name): HEALTHQUEST MEDICAL CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 06/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 N SOLANO DR STE:A
LAS CRUCES NM
88001-2366
US

IV. Provider business mailing address

PO BOX 13148
LAS CRUCES NM
88013-3148
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-4040
  • Fax: 575-541-1069
Mailing address:
  • Phone: 575-642-6738
  • Fax: 575-541-1069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROMANA R SAAVEDRA
Title or Position: WIFE OF MD-OWNER
Credential: MGR
Phone: 575-642-6738