Healthcare Provider Details

I. General information

NPI: 1245559400
Provider Name (Legal Business Name): MONICA HILDA MOYA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 S ALAMEDA BLVD
LAS CRUCES NM
88005-2818
US

IV. Provider business mailing address

385 CALLE DE ALEGRA BLDG A
LAS CRUCES NM
88005-3417
US

V. Phone/Fax

Practice location:
  • Phone: 575-528-6400
  • Fax: 575-521-7199
Mailing address:
  • Phone: 575-526-1105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2013-0070
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: