Healthcare Provider Details

I. General information

NPI: 1457168379
Provider Name (Legal Business Name): GUIDING STAR SOUTHWEST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2024
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2908 HILLRISE DR
LAS CRUCES NM
88011-4702
US

IV. Provider business mailing address

1411 MONTANA AVE
EL PASO TX
79902-5617
US

V. Phone/Fax

Practice location:
  • Phone: 915-544-9600
  • Fax:
Mailing address:
  • Phone: 915-544-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARK CAVALIERE
Title or Position: CEO
Credential:
Phone: 915-544-9600