Healthcare Provider Details

I. General information

NPI: 1477804409
Provider Name (Legal Business Name): LAS CRUCES CANCER CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 MALL DR SUITE B
LAS CRUCES NM
88011-8101
US

IV. Provider business mailing address

1180 MALL DR SUITE B
LAS CRUCES NM
88011-8101
US

V. Phone/Fax

Practice location:
  • Phone: 575-521-4601
  • Fax:
Mailing address:
  • Phone: 575-521-4601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number2001-330
License Number StateNM

VIII. Authorized Official

Name: CONSTANCE D WASH
Title or Position: PRESIDENT
Credential: MD
Phone: 575-521-4601