Healthcare Provider Details

I. General information

NPI: 1104611375
Provider Name (Legal Business Name): VICTORIA NAVARRETE OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 SAMARITAN DR STE 101-A
LAS CRUCES NM
88001-1170
US

IV. Provider business mailing address

2550 SAMARITAN DR STE 101-A
LAS CRUCES NM
88001-1170
US

V. Phone/Fax

Practice location:
  • Phone: 575-592-2088
  • Fax:
Mailing address:
  • Phone: 575-592-2088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT22048
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: