Healthcare Provider Details

I. General information

NPI: 1033833876
Provider Name (Legal Business Name): JASMINE RENTERIA MSW INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 OAK ST
LAS CRUCES NM
88005-3769
US

IV. Provider business mailing address

3100 OAK ST
LAS CRUCES NM
88005-3769
US

V. Phone/Fax

Practice location:
  • Phone: 575-523-2288
  • Fax: 575-523-2299
Mailing address:
  • Phone: 575-523-2288
  • Fax: 575-523-2299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberSWB20240090
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: