Healthcare Provider Details

I. General information

NPI: 1831628551
Provider Name (Legal Business Name): ROBERTO TALAMANTES MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2903 HILLRISE DR
LAS CRUCES NM
88011-4701
US

IV. Provider business mailing address

2903 HILLRISE DR
LAS CRUCES NM
88011-4701
US

V. Phone/Fax

Practice location:
  • Phone: 575-521-1378
  • Fax: 575-522-5744
Mailing address:
  • Phone: 575-521-1378
  • Fax: 575-522-5744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number84-273
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number84-273
License Number StateNM

VIII. Authorized Official

Name: DR. ROBERTO TALAMANTES
Title or Position: DEVELOPMENTAL PEDIATRICIAN
Credential: MD
Phone: 575-521-1378