Healthcare Provider Details

I. General information

NPI: 1740694223
Provider Name (Legal Business Name): SONOMA URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 06/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2970 N MAIN ST
LAS CRUCES NM
88001-1152
US

IV. Provider business mailing address

4371 E. LOHMAN AVE.
LAS CRUCES NM
88011-8255
US

V. Phone/Fax

Practice location:
  • Phone: 575-532-8900
  • Fax: 575-532-8963
Mailing address:
  • Phone: 575-532-8900
  • Fax: 575-532-8963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. EUGENE SAMUEL
Title or Position: ADMINISTRATOR
Credential:
Phone: 575-532-8900