Healthcare Provider Details

I. General information

NPI: 1588172290
Provider Name (Legal Business Name): CECILIA ISOLINA KASBOHM CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 02/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 W AMADOR AVE STE A
LAS CRUCES NM
88005-2739
US

IV. Provider business mailing address

PO BOX 14232
LAS CRUCES NM
88013-4232
US

V. Phone/Fax

Practice location:
  • Phone: 575-556-9681
  • Fax:
Mailing address:
  • Phone: 575-532-5455
  • Fax: 575-532-5641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP03471
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: