Healthcare Provider Details

I. General information

NPI: 1982997425
Provider Name (Legal Business Name): FULL BLOOM PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2011
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4181 CAMINO COYOTE
LAS CRUCES NM
88011-7096
US

IV. Provider business mailing address

4181 CAMINO COYOTE
LAS CRUCES NM
88011-7096
US

V. Phone/Fax

Practice location:
  • Phone: 575-532-6006
  • Fax: 575-532-9049
Mailing address:
  • Phone: 575-532-6006
  • Fax: 575-532-9049

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. CYNTHIA R SETTLES
Title or Position: OWNER
Credential: M.D.
Phone: 575-532-6006