Healthcare Provider Details

I. General information

NPI: 1710265079
Provider Name (Legal Business Name): TESORO INTEGRATIVE HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2011
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 S MAIN ST BLDG A
LAS CRUCES NM
88005-3124
US

IV. Provider business mailing address

1605 S MAIN ST BLDG A
LAS CRUCES NM
88005-3124
US

V. Phone/Fax

Practice location:
  • Phone: 575-541-5660
  • Fax:
Mailing address:
  • Phone: 575-541-5660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. PATRICIA SUSAN MCCLURE
Title or Position: OWNER
Credential: M.A.
Phone: 575-541-5660