Healthcare Provider Details

I. General information

NPI: 1720694169
Provider Name (Legal Business Name): LOS NINOS PEDIATRIC URGENT CARE, L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S DON ROSER DR
LAS CRUCES NM
88011-4538
US

IV. Provider business mailing address

1180 COMMERCE DR UNIT 13190
LAS CRUCES NM
88013-4608
US

V. Phone/Fax

Practice location:
  • Phone: 575-636-5061
  • Fax:
Mailing address:
  • Phone: 575-636-5061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANNE LOUISE GOMEZ
Title or Position: DIRECTOR
Credential: M.D.
Phone: 575-636-5061