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General NPI Number Information
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NPI Number | 1720873441
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Entity Type | Organization
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Legal Business Name | ELITE LYMPHEDEMA AND LASER INSTITUTE LLC
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Dates
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Enumeration Date | 04/12/2025
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Last Update Date | 04/12/2025
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Provider Practice Location Address
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Address Line | 532 N TELSHOR BLVD STE H
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City | LAS CRUCES
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State | NM
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Zip | 88011-8234
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Country | US
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Telephone | 575-205-2288
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Fax |
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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 | 575-644-9340
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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