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General NPI Number Information
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NPI Number | 1629600556
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Entity Type | Individual
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Provider Name | RUBEN COSTALES NANEZ MT ASCP
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Gender | Male
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Dates
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Enumeration Date | 02/09/2020
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Last Update Date | 02/09/2020
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Provider Practice Location Address
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Address Line | 661 WENDY LN
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City | LAS CRUCES
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State | NM
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Zip | 88007-5324
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Country | US
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Telephone | 575-649-1847
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Fax |
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Provider Business Mailing Address
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Address Line | 661 WENDY LN
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City | LAS CRUCES
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State | NM
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Zip | 88007-5324
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Country | US
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Telephone | 575-649-1847
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Fax |
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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 | 246QM0706X
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Taxonomy Name | Medical Technologist
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License Number | MT175482
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License Number State | NM
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