Healthcare Provider Details

I. General information

NPI: 1942291927
Provider Name (Legal Business Name): SAN CURTIS SHIELDS CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 N TELSHOR . STE. C LAS CRUCES QUICK CARE
LAS CRUCES NM
88011
US

IV. Provider business mailing address

540 WALTON BLVD STE C NEW URGENT CARE
LAS CRUCES NM
88001-8433
US

V. Phone/Fax

Practice location:
  • Phone: 575-532-2004
  • Fax: 575-532-2441
Mailing address:
  • Phone: 575-525-2700
  • Fax: 575-521-0793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR24296
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: