Healthcare Provider Details

I. General information

NPI: 1215379284
Provider Name (Legal Business Name): CENTRAL MEDICAL SERVICES OF SOUTHERN NEW MEXICO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2013
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 N ROADRUNNER PKWY STE 224
LAS CRUCES NM
88011-2001
US

IV. Provider business mailing address

141 N ROADRUNNER PKWY STE 224
LAS CRUCES NM
88011-2001
US

V. Phone/Fax

Practice location:
  • Phone: 575-524-8888
  • Fax: 575-524-8132
Mailing address:
  • Phone: 575-524-8888
  • Fax: 575-524-8132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RICARDO RUBIO
Title or Position: OWNER
Credential: MD
Phone: 575-524-8888