Healthcare Provider Details

I. General information

NPI: 1760476139
Provider Name (Legal Business Name): NEUROLOGY ASSOCIATES OF MESILLA VALLEY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3855 FOOTHILLS DRIVE
LAS CRUCES NM
88011
US

IV. Provider business mailing address

3855 FOOTHILLS DRIVE
LAS CRUCES NM
88011
US

V. Phone/Fax

Practice location:
  • Phone: 575-532-8561
  • Fax: 575-532-8567
Mailing address:
  • Phone: 575-532-8561
  • Fax: 575-532-8567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberK2499
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number92256
License Number StateNM

VIII. Authorized Official

Name: JAVED IQBAL
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 575-532-8561