Healthcare Provider Details

I. General information

NPI: 1235484304
Provider Name (Legal Business Name): LAS CRUCES PHYSICIAN PRACTICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2012
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 S TRIVIZ DR SUITE H
LAS CRUCES NM
88001-0605
US

IV. Provider business mailing address

PO BOX 6310
LAS CRUCES NM
88006-6310
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-9793
  • Fax: 575-532-9019
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLOTTE LAWRENCE
Title or Position: SECRETARY
Credential:
Phone: 615-920-7000