Healthcare Provider Details

I. General information

NPI: 1952761058
Provider Name (Legal Business Name): RACHEL VILLA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2016
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4371 E LOHMAN AVE
LAS CRUCES NM
88011-8255
US

IV. Provider business mailing address

2970 N MAIN ST
LAS CRUCES NM
88001-1152
US

V. Phone/Fax

Practice location:
  • Phone: 575-532-8900
  • Fax:
Mailing address:
  • Phone: 575-525-3531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95002928
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number62024
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: