Healthcare Provider Details

I. General information

NPI: 1538719372
Provider Name (Legal Business Name): IYAMU ANESTHESIA SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 09/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 S WALNUT ST
LAS CRUCES NM
88001-3955
US

IV. Provider business mailing address

205 W BOUTZ RD BLDG 1
LAS CRUCES NM
88005-3259
US

V. Phone/Fax

Practice location:
  • Phone: 915-246-1352
  • Fax:
Mailing address:
  • Phone: 575-532-7033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: IKE I IYAMU
Title or Position: CRNA/OWNER
Credential:
Phone: 713-591-2433