Healthcare Provider Details

I. General information

NPI: 1023307956
Provider Name (Legal Business Name): DARCY PENA CSFA, CST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2011
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4143 LA PURISIMA DR
LAS CRUCES NM
88011-8430
US

IV. Provider business mailing address

205 W BOUTZ RD BLDG #1
LAS CRUCES NM
88005-3259
US

V. Phone/Fax

Practice location:
  • Phone: 575-805-5801
  • Fax: 575-532-7006
Mailing address:
  • Phone: 575-532-7000
  • Fax: 575-532-7006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: