Basic Information
| Provider Information | |||||||||
| NPI: | 1831385863 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAS CRUCES BEHAVIORAL MEDICINE ASSOCIATES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1505 S DON ROSER DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880114596 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5755213388 | ||||||||
| FaxNumber: | 5755214023 | ||||||||
| Practice Location | |||||||||
| Address1: | 1505 S DON ROSER DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880114596 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5755213388 | ||||||||
| FaxNumber: | 5755214023 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2007 | ||||||||
| LastUpdateDate: | 09/16/2014 | ||||||||
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| AuthorizedOfficialLastName: | HERNANDEZ | ||||||||
| AuthorizedOfficialFirstName: | GABRIEL | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5755213388 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.