Healthcare Provider Details

I. General information

NPI: 1699883132
Provider Name (Legal Business Name): NEW MEXICO CARDIAC CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4351 E LOHMAN AVE SUITE 100
LAS CRUCES NM
88011-8259
US

IV. Provider business mailing address

4351 E LOHMAN AVE SUITE 100
LAS CRUCES NM
88011-8259
US

V. Phone/Fax

Practice location:
  • Phone: 505-521-3270
  • Fax: 505-521-3504
Mailing address:
  • Phone: 505-521-3270
  • Fax: 505-521-3504

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: MRS. ESTELLA M CANNON
Title or Position: SECRETARY/PRACTICE ADMINISTRATOR
Credential:
Phone: 505-521-3270