Healthcare Provider Details

I. General information

NPI: 1497074850
Provider Name (Legal Business Name): LAS CRUCES CARDIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 11/15/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 FOOTHILLS RD STE A
LAS CRUCES NM
88011-5144
US

IV. Provider business mailing address

5746 TROWBRIDGE DR
EL PASO TX
79925-3341
US

V. Phone/Fax

Practice location:
  • Phone: 575-521-3500
  • Fax: 575-386-4199
Mailing address:
  • Phone: 915-219-4300
  • Fax: 915-519-4300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD2007-0192
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD2007-0192
License Number StateNM

VIII. Authorized Official

Name: DR. AXEL ZAGLER LUNA
Title or Position: MANAGER
Credential: M.D.
Phone: 575-521-3500