Healthcare Provider Details

I. General information

NPI: 1649677360
Provider Name (Legal Business Name): EDGAR ANDRES CHICA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 02/09/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3751 DEL REY BOULEVARD MESILLA VALLEY HOSPITAL
LAS CRUCES NM
88012
US

IV. Provider business mailing address

6612 HERITAGE RIDGE WAY
EL PASO TX
79912-8124
US

V. Phone/Fax

Practice location:
  • Phone: 575-382-6697
  • Fax:
Mailing address:
  • Phone: 516-448-2803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD2023-1429
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: