Healthcare Provider Details

I. General information

NPI: 1982473377
Provider Name (Legal Business Name): CHRISTIN MONARAE ZAMORA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2023
Last Update Date: 01/22/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 BRELAND DR
LAS CRUCES NM
88003
US

IV. Provider business mailing address

7064 CHACO ST
LAS CRUCES NM
88012-0826
US

V. Phone/Fax

Practice location:
  • Phone: 575-654-5737
  • Fax:
Mailing address:
  • Phone: 575-654-5737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number77207
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: