Healthcare Provider Details

I. General information

NPI: 1417538927
Provider Name (Legal Business Name): SOUTH WEST HELPING HANDS SURGICAL ASSISTANT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 ITHACA CT APT 901
LAS CRUCES NM
88011-7182
US

IV. Provider business mailing address

455 ITHACA CT APT 901
LAS CRUCES NM
88011-7182
US

V. Phone/Fax

Practice location:
  • Phone: 518-361-4912
  • Fax:
Mailing address:
  • Phone: 518-361-4912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AMALIA N/A GUTIERREZ
Title or Position: SURGICAL ASSISTANT
Credential: CSFA
Phone: 518-361-4912