Healthcare Provider Details

I. General information

NPI: 1992860712
Provider Name (Legal Business Name): SOUTHWEST HEALTH SERVICES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 09/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 S TELSHOR BLVD STE B2
LAS CRUCES NM
88011-5071
US

IV. Provider business mailing address

2525 S TELSHOR BLVD STE B2
LAS CRUCES NM
88011-5071
US

V. Phone/Fax

Practice location:
  • Phone: 575-521-1575
  • Fax: 575-521-1940
Mailing address:
  • Phone: 575-521-1575
  • Fax: 575-521-1940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. OSVALDO RENE DE LA VEGA
Title or Position: PRESIDENT
Credential: MD
Phone: 575-521-1575