MEDICARE: NEW MEXICO MEDICAL CARDIOLOGY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	MD2013-0055	NM

General Provider Information

NPI Number	:	1124433388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW MEXICO MEDICAL CARDIOLOGY LLC

Provider Business Mailing Address
First Line	:	205 W BOUTZ RD
Second Line	:	BLDG #1
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-3259
Country	:	US
Telephone Number	:	575-532-7000
Fax Number	:	575-532-7111

Provider Business Practice Location Address
First Line	:	2930 HILLRISE DR
Second Line	:	STE. 2
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4776
Country	:	US
Telephone Number	:	575-532-1111
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AZIM SAQUIB
Credential	:	M.D.
Telephone Number	:	480-707-1648

Provider Enumeration Date	:	06/26/2014
Last Update Date	:	06/26/2014

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