Healthcare Provider Details

I. General information

NPI: 1528993201
Provider Name (Legal Business Name): FATIMA GUADERRAMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 S MAIN ST STE C
LAS CRUCES NM
88005-3797
US

IV. Provider business mailing address

3201 S MAIN ST STE C
LAS CRUCES NM
88005-3797
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-8378
  • Fax: 575-652-3149
Mailing address:
  • Phone: 575-522-8378
  • Fax: 575-652-3149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberG-2082
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: