Healthcare Provider Details

I. General information

NPI: 1548071475
Provider Name (Legal Business Name): ELITE MEDICAL AESTHETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 01/20/2025
Certification Date: 01/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 FOOTHILLS RD STE A
LAS CRUCES NM
88011-5144
US

IV. Provider business mailing address

PO BOX 2845
LAS CRUCES NM
88004-2845
US

V. Phone/Fax

Practice location:
  • Phone: 575-392-7958
  • Fax: 575-236-4667
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAIME SANCHEZ
Title or Position: CEO
Credential: CNP
Phone: 575-993-9890