Healthcare Provider Details

I. General information

NPI: 1821895871
Provider Name (Legal Business Name): GERARDO RAFAEL CHAVEZ MLS (ASCP), MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 BRELAND DR.
LAS CRUCES NM
88003
US

IV. Provider business mailing address

PO BOX 30001
LAS CRUCES NM
88003-8001
US

V. Phone/Fax

Practice location:
  • Phone: 575-646-6426
  • Fax:
Mailing address:
  • Phone: 575-646-6426
  • Fax: 575-646-6428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number249997
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number249997
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: