Healthcare Provider Details

I. General information

NPI: 1063785921
Provider Name (Legal Business Name): MESILLA VALLEY PAIN CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2012
Last Update Date: 02/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 S TELSHOR BLVD STE A
LAS CRUCES NM
88011-4731
US

IV. Provider business mailing address

205 W BOUTZ RD BLDG 1
LAS CRUCES NM
88005-3259
US

V. Phone/Fax

Practice location:
  • Phone: 575-556-9776
  • Fax: 575-652-4666
Mailing address:
  • Phone: 575-532-7000
  • Fax: 575-532-7025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CESAR VELARDE
Title or Position: MD/SOLE OWNER
Credential:
Phone: 575-556-9776