Healthcare Provider Details

I. General information

NPI: 1851701015
Provider Name (Legal Business Name): SERGIO ESPARZA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2014
Last Update Date: 04/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 EL PASEO RD.
LAS CRUCES NM
88001
US

IV. Provider business mailing address

800 EL PASEO RD
LAS CRUCES NM
88001-6050
US

V. Phone/Fax

Practice location:
  • Phone: 575-201-4336
  • Fax: 575-636-2884
Mailing address:
  • Phone: 575-201-4336
  • Fax: 575-636-2884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number03-286769-00-7
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: