Healthcare Provider Details

I. General information

NPI: 1790976512
Provider Name (Legal Business Name): LAURA M ROSALES R.D., L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 02/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4371 E LOHMAN AVE
LAS CRUCES NM
88011-8443
US

IV. Provider business mailing address

4371 E LOHMAN AVE
LAS CRUCES NM
88011-8443
US

V. Phone/Fax

Practice location:
  • Phone: 575-532-8900
  • Fax: 575-532-8910
Mailing address:
  • Phone: 575-532-8900
  • Fax: 575-532-8910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT06119
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD0748
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: