Healthcare Provider Details

I. General information

NPI: 1750211629
Provider Name (Legal Business Name): MARC ANTHONY VENEGAS CCSS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 S MELENDRES ST
LAS CRUCES NM
88005-2805
US

IV. Provider business mailing address

2877 SAN MIGUEL CT
LAS CRUCES NM
88007-1948
US

V. Phone/Fax

Practice location:
  • Phone: 575-299-8843
  • Fax:
Mailing address:
  • Phone: 575-294-9768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: