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General NPI Number Information
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NPI Number | 1548071475
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Entity Type | Organization
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Legal Business Name | ELITE MEDICAL AESTHETICS LLC
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Dates
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Enumeration Date | 01/20/2025
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 3825 FOOTHILLS RD STE A
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City | LAS CRUCES
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State | NM
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Zip | 88011-5144
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Country | US
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Telephone | 575-392-7958
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Fax | 575-236-4667
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Provider Business Mailing Address
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Address Line | PO BOX 2845
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City | LAS CRUCES
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State | NM
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Zip | 88004-2845
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JAIME SANCHEZ
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Credential | CNP
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Telephone | 575-993-9890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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