Provider Demographics
NPI:1033413752
Name:PARCO, ANIA (MPT)
Entity Type:Individual
Prefix:
First Name:ANIA
Middle Name:
Last Name:PARCO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4039 LA PURISIMA DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4170
Mailing Address - Country:US
Mailing Address - Phone:575-556-8440
Mailing Address - Fax:575-556-8439
Practice Address - Street 1:2455 MISSOURI AVE STE B
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-5122
Practice Address - Country:US
Practice Address - Phone:575-556-8440
Practice Address - Fax:575-556-8439
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3931174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist