MEDICARE: MARIA PROTEXTOR

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1770904179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA PROTEXTOR

Provider Business Mailing Address
First Line	:	334 LINDA VISTA RD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-2008
Country	:	US
Telephone Number	:	575-993-1016
Fax Number	:

Provider Business Practice Location Address
First Line	:	334 LINDA VISTA RD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-2008
Country	:	US
Telephone Number	:	575-993-1016
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2014
Last Update Date	:	01/02/2014

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Directions to “ MARIA PROTEXTOR ” Practice Location

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