Healthcare Provider Details

I. General information

NPI: 1205981339
Provider Name (Legal Business Name): REHABILITATION & OCCUPATIONAL MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 FOOTHILLS RD SUITE N
LAS CRUCES NM
88011-3626
US

IV. Provider business mailing address

PO BOX 1420
LAS CRUCES NM
88004-1420
US

V. Phone/Fax

Practice location:
  • Phone: 575-532-6054
  • Fax: 575-532-0215
Mailing address:
  • Phone: 575-532-6054
  • Fax: 575-532-0215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number89-180
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number89-180
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2000-186
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1661
License Number StateNM

VIII. Authorized Official

Name: DR. BRIAN P DELAHOUSSAYE
Title or Position: MEDICAL DIRECTOR/OWNER
Credential: M.D.
Phone: 575-532-6054