Healthcare Provider Details

I. General information

NPI: 1831801141
Provider Name (Legal Business Name): MARIA D GUILLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA D GUILLEN

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 S TELSHOR BLVD STE 100
LAS CRUCES NM
88011-8683
US

IV. Provider business mailing address

PO BOX 221530
EL PASO TX
79913-4530
US

V. Phone/Fax

Practice location:
  • Phone: 575-395-7246
  • Fax: 575-652-4607
Mailing address:
  • Phone: 915-598-7246
  • Fax: 915-633-6598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1102072
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: