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General NPI Number Information
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NPI Number | 1871375212
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Entity Type | Organization
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Legal Business Name | NEW MEXICO TRUECARE FAMILY PRACTICE LLC
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Dates
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Enumeration Date | 10/19/2023
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Last Update Date | 01/31/2024
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Provider Practice Location Address
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Address Line | 9 PINE RIDGE DR
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City | LAS VEGAS
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State | NM
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Zip | 87701-9685
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Country | US
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Telephone | 505-426-5682
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Fax |
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Provider Business Mailing Address
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Address Line | 9 PINE RIDGE DR
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City | LAS VEGAS
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State | NM
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Zip | 87701-9685
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Country | US
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Telephone | 505-426-5682
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED REPRESENTATIVE
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Name | DANYELLE MARIE ROMERO
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Credential | CNP
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Telephone | 505-426-5682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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