Healthcare Provider Details

I. General information

NPI: 1629622055
Provider Name (Legal Business Name): SOUTHERN NEW MEXICO HEART AND VASCULAR GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 07/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3865 E LOHMAN AVE STE 4
LAS CRUCES NM
88011-8292
US

IV. Provider business mailing address

3865 E LOHMAN AVE STE 4
LAS CRUCES NM
88011-8292
US

V. Phone/Fax

Practice location:
  • Phone: 575-532-5838
  • Fax: 575-532-1778
Mailing address:
  • Phone: 575-532-5838
  • Fax: 575-532-1778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: ANGIE B CRISTO
Title or Position: MANAGER
Credential:
Phone: 575-532-5838