Healthcare Provider Details

I. General information

NPI: 1780417659
Provider Name (Legal Business Name): MRS. GINA MARIE SELGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2024
Last Update Date: 08/24/2024
Certification Date: 08/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2013 BRIARWOOD LN
LAS CRUCES NM
88005-1524
US

IV. Provider business mailing address

2013 BRIARWOOD LN
LAS CRUCES NM
88005-1524
US

V. Phone/Fax

Practice location:
  • Phone: 575-640-1320
  • Fax:
Mailing address:
  • Phone: 575-640-1320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: