Healthcare Provider Details

I. General information

NPI: 1609171768
Provider Name (Legal Business Name): EDUARDO BERUMEN RN. FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2011
Last Update Date: 01/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4351 E. LOHMAN AVE. SUITE 301
LAS CRUCES NM
88011
US

IV. Provider business mailing address

844 HEMPSTEAD DR.
EL PASO TX
79912
US

V. Phone/Fax

Practice location:
  • Phone: 575-532-8900
  • Fax:
Mailing address:
  • Phone: 915-833-3184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number561813
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: