Healthcare Provider Details

I. General information

NPI: 1245054857
Provider Name (Legal Business Name): MERAZ FAMILY HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4131 CAMINO COYOTE STE C
LAS CRUCES NM
88011-3000
US

IV. Provider business mailing address

6507 CHUKAR CT
LAS CRUCES NM
88012-7084
US

V. Phone/Fax

Practice location:
  • Phone: 575-800-7410
  • Fax: 575-800-7199
Mailing address:
  • Phone: 575-621-9689
  • Fax:

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: ROSA L MERAZ
Title or Position: OWNER/PROVIDER
Credential: NP
Phone: 575-800-7410