Healthcare Provider Details

I. General information

NPI: 1609343185
Provider Name (Legal Business Name): HYGIA PAIN INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2018
Last Update Date: 11/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 E LOHMAN AVE BLDG SUITE4
LAS CRUCES NM
88011-8296
US

IV. Provider business mailing address

4849 N MESA ST STE 201
EL PASO TX
79912-5919
US

V. Phone/Fax

Practice location:
  • Phone: 915-351-6600
  • Fax:
Mailing address:
  • Phone: 915-351-6600
  • Fax: 915-351-6601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: AARON VILLARREAL
Title or Position: OWNER
Credential: CRNA
Phone: 915-276-9075