Healthcare Provider Details

I. General information

NPI: 1356537468
Provider Name (Legal Business Name): JOSEPH C YAROCH MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 LA QUINTA ST
LAS CRUCES NM
88007-4810
US

IV. Provider business mailing address

1081 LA QUINTA ST
LAS CRUCES NM
88007-4810
US

V. Phone/Fax

Practice location:
  • Phone: 505-524-4054
  • Fax: 505-524-4054
Mailing address:
  • Phone: 505-524-4054
  • Fax: 505-524-4054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberMD2007-0611
License Number StateNM

VIII. Authorized Official

Name: DR. JOSEPH C YAROCH
Title or Position: SOLE PROPRIETOR
Credential: M.D.
Phone: 505-524-4054