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General NPI Number Information
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NPI Number | 1275067613
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Entity Type | Individual
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Provider Name | JOSE LUIS HENAO MD
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Gender | Male
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Dates
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Enumeration Date | 04/12/2017
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 3900 E LOHMAN AVE STE B
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City | LAS CRUCES
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State | NM
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Zip | 88011-8268
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Country | US
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Telephone | 575-522-5752
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Fax | 575-522-5722
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Provider Business Mailing Address
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Address Line | 3821 MASTHEAD ST NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-4679
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Country | US
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Telephone | 505-998-7400
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Fax | 505-998-7740
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | MD2023-1540
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 13298
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License Number State | SD
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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