Healthcare Provider Details

I. General information

NPI: 1821122672
Provider Name (Legal Business Name): VICTOR A. NWACHUKU, M.D., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1618 EAST PINE STREET
SILVER CITY NM
88061-1260
US

IV. Provider business mailing address

1618 E PINE ST
SILVER CITY NM
88061-7155
US

V. Phone/Fax

Practice location:
  • Phone: 575-388-1561
  • Fax: 575-388-9952
Mailing address:
  • Phone: 575-388-1561
  • Fax: 575-388-9952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: JUSTINE MUNOZ
Title or Position: PRACTICE MANAGER
Credential:
Phone: 575-388-1561