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Contact Information

FAMILY PRACTICE MEDICAL AND DIETETIC MEDICAL THERAPY
2904 HILLRISE DR
LAS CRUCES, NM88011-4702
 Phone: 575-532-5386
 Fax: 575-532-5449
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Primary Care

363LP2300X 50 Nurse Practitioner
 

Dietitian, Registered

133V00000X 71 Registered Dietitian or Nutrition Professional
Indicates primary specialty

NPI Profile & details for FAMILY PRACTICE MEDICAL AND DIETETIC MEDICAL THERAPY

NPI # 1609199447
LBN Legal business name FAMILY PRACTICE MEDICAL AND DIETETIC MEDICAL THERAPY
Authorized official JOSE ROSALES - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 03/08/2010
Last updated 03/29/2013 - About 13 years ago
Identifiers
NM License # CNP00942
NM License # LD0748
TX License # DT06119
NM Medicaid 58878335
NM Other 1609199447 BCBS
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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