Healthcare Provider Details

I. General information

NPI: 1821915182
Provider Name (Legal Business Name): POR VIDA FAMILY HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1980 E LOHMAN AVE BLDG 1
LAS CRUCES NM
88001-3194
US

IV. Provider business mailing address

1980 E LOHMAN AVE BLDG 1
LAS CRUCES NM
88001-3194
US

V. Phone/Fax

Practice location:
  • Phone: 575-652-1300
  • Fax:
Mailing address:
  • Phone: 575-652-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MAI OUSHY
Title or Position: PROVIDER
Credential: MD
Phone: 575-652-1300