Healthcare Provider Details
I. General information
NPI: 1043342090
Provider Name (Legal Business Name): NUESTRO FUTURO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 03/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2904 HILLRISE DR
LAS CRUCES NM
88011-4702
US
IV. Provider business mailing address
PO BOX 1560
LAS CRUCES NM
88004-1560
US
V. Phone/Fax
- Phone: 505-521-7227
- Fax: 505-521-7233
- Phone: 505-647-8366
- Fax: 505-647-8381
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208000000X |
| Taxonomy | Pediatrics Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
EILEEN
LUQUE
BROWN
Title or Position: OWNER
Credential: M.D
Phone: 505-647-8366