Healthcare Provider Details

I. General information

NPI: 1609039783
Provider Name (Legal Business Name): GEERT CUYPERS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 PERKINS DR STE C
LAS CRUCES NM
88005-3248
US

IV. Provider business mailing address

301 PERKINS DR STE C
LAS CRUCES NM
88005-3248
US

V. Phone/Fax

Practice location:
  • Phone: 505-523-7243
  • Fax: 505-525-5641
Mailing address:
  • Phone: 505-523-7243
  • Fax: 505-525-5641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2213
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: