Healthcare Provider Details

I. General information

NPI: 1659135093
Provider Name (Legal Business Name): CRYSTAL PADILLA SERNA LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2024
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N CHURCH ST STE 508
LAS CRUCES NM
88001-3440
US

IV. Provider business mailing address

500 N CHURCH ST STE 508
LAS CRUCES NM
88001-3440
US

V. Phone/Fax

Practice location:
  • Phone: 575-993-9519
  • Fax:
Mailing address:
  • Phone: 575-993-9519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-2023-0012
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: