Healthcare Provider Details

I. General information

NPI: 1962671263
Provider Name (Legal Business Name): SURGICAL PARTNERS OF LAS CRUCES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 11/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 S TELSHOR BLVD
LAS CRUCES NM
88011-4748
US

IV. Provider business mailing address

1205 S TELSHOR BLVD
LAS CRUCES NM
88011-4748
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-6144
  • Fax: 575-522-6171
Mailing address:
  • Phone: 575-522-6144
  • Fax: 575-522-6171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number3332
License Number StateNM

VIII. Authorized Official

Name: MRS. DELILAH PRIETO
Title or Position: ADMINISTRATOR
Credential:
Phone: 575-522-6144