Healthcare Provider Details

I. General information

NPI: 1649767278
Provider Name (Legal Business Name): MATTHEW ENDRIZZI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N ROADRUNNER PKWY
LAS CRUCES NM
88011-7044
US

IV. Provider business mailing address

150 N ROADRUNNER PKWY
LAS CRUCES NM
88011-7044
US

V. Phone/Fax

Practice location:
  • Phone: 575-556-6440
  • Fax:
Mailing address:
  • Phone: 575-556-6440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2022-1052
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: