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General NPI Number Information
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NPI Number | 1821915182
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Entity Type | Organization
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Legal Business Name | POR VIDA FAMILY HEALTHCARE LLC
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Dates
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Enumeration Date | 06/29/2026
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Last Update Date | 06/29/2026
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Provider Practice Location Address
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Address Line | 1980 E LOHMAN AVE BLDG 1
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City | LAS CRUCES
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State | NM
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Zip | 88001-3194
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Country | US
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Telephone | 575-652-1300
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Fax |
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Provider Business Mailing Address
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Address Line | 1980 E LOHMAN AVE BLDG 1
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City | LAS CRUCES
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State | NM
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Zip | 88001-3194
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Country | US
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Telephone | 575-652-1300
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | MAI OUSHY
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Credential | MD
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Telephone | 575-652-1300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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