Healthcare Provider Details

I. General information

NPI: 1144184227
Provider Name (Legal Business Name): TRIPLE J FABRICATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 OLD PICACHO ROAD
LAS CRUCES NM
88007
US

IV. Provider business mailing address

PO BOX 503
FAIRACRES NM
88033-0503
US

V. Phone/Fax

Practice location:
  • Phone: 575-650-9614
  • Fax:
Mailing address:
  • Phone: 575-650-9614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: BRIANNA LUCERO
Title or Position: MANAGER
Credential:
Phone: 575-650-9614