Healthcare Provider Details

I. General information

NPI: 1902000813
Provider Name (Legal Business Name): MARIA G. CRAWLEY MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 MISSOURI AVE STE. 27
LAS CRUCES NM
88011-5075
US

IV. Provider business mailing address

PO BOX 1560
LAS CRUCES NM
88004-1560
US

V. Phone/Fax

Practice location:
  • Phone: 505-647-8366
  • Fax: 505-647-8381
Mailing address:
  • Phone: 505-647-8366
  • Fax: 505-647-8381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number84-170
License Number StateNM

VIII. Authorized Official

Name: MS. KATRINA FERRALES
Title or Position: CREDENTIALING
Credential:
Phone: 505-647-8366