Healthcare Provider Details

I. General information

NPI: 1295603264
Provider Name (Legal Business Name): JIMMY SILVA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2025
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 CALLE DE LAS FAMILIAS NW
LOS LUNAS NM
87031-8408
US

IV. Provider business mailing address

350 CALLE DE LAS FAMILIAS NW
LOS LUNAS NM
87031-8408
US

V. Phone/Fax

Practice location:
  • Phone: 505-577-9177
  • Fax:
Mailing address:
  • Phone: 505-577-9177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: