Healthcare Provider Details

I. General information

NPI: 1467381996
Provider Name (Legal Business Name): MR. SETH EISENBERG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 N SOLANO DR
LAS CRUCES NM
88001-1845
US

IV. Provider business mailing address

1501 N SOLANO DR
LAS CRUCES NM
88001-1845
US

V. Phone/Fax

Practice location:
  • Phone: 575-652-3646
  • Fax:
Mailing address:
  • Phone: 575-652-3646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: