Healthcare Provider Details

I. General information

NPI: 1730985276
Provider Name (Legal Business Name): NEW MEXICO MEDICAL & INJURY CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2457 S TELSHOR BLVD
LAS CRUCES NM
88011-5049
US

IV. Provider business mailing address

2457 S TELSHOR BLVD
LAS CRUCES NM
88011-5049
US

V. Phone/Fax

Practice location:
  • Phone: 575-259-6478
  • Fax:
Mailing address:
  • Phone: 575-259-6478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: PHILIP RODRIGUEZ
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 505-364-6804