Healthcare Provider Details

I. General information

NPI: 1992217665
Provider Name (Legal Business Name): MICHAEL A JAUREQUI FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2017
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1998 N MOTEL BLVD
LAS CRUCES NM
88007
US

IV. Provider business mailing address

PO BOX 370
HATCH NM
87937-0370
US

V. Phone/Fax

Practice location:
  • Phone: 575-541-5941
  • Fax: 575-541-5048
Mailing address:
  • Phone: 575-267-3280
  • Fax: 575-267-1747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-03438
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: