Healthcare Provider Details

I. General information

NPI: 1053009431
Provider Name (Legal Business Name): DAVID A YANEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 W AMADOR AVE STE A
LAS CRUCES NM
88005-2739
US

IV. Provider business mailing address

3402 BIXLER DR APT 707
LAS CRUCES NM
88012-5107
US

V. Phone/Fax

Practice location:
  • Phone: 575-527-5482
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2026-0006
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: