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General NPI Number Information
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NPI Number | 1710265079
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Entity Type | Organization
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Legal Business Name | TESORO INTEGRATIVE HEALTH CENTER
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Dates
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Enumeration Date | 08/03/2011
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Last Update Date | 02/06/2013
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Provider Practice Location Address
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Address Line | 1605 S MAIN ST BLDG A
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City | LAS CRUCES
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State | NM
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Zip | 88005-3124
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Country | US
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Telephone | 575-541-5660
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Fax |
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Provider Business Mailing Address
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Address Line | 1605 S MAIN ST BLDG A
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City | LAS CRUCES
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State | NM
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Zip | 88005-3124
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Country | US
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Telephone | 575-541-5660
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. PATRICIA SUSAN MCCLURE
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Credential | M.A.
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Telephone | 575-541-5660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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