Provider Demographics
NPI:1184005860
Name:NM OPTIMUM MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:NM OPTIMUM MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCOS
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-522-1200
Mailing Address - Street 1:425 S TELSHOR BLVD # C201B
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8235
Mailing Address - Country:US
Mailing Address - Phone:575-522-1200
Mailing Address - Fax:575-288-2063
Practice Address - Street 1:425 S TELSHOR BLVD # C201B
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8235
Practice Address - Country:US
Practice Address - Phone:575-522-1200
Practice Address - Fax:575-288-2063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-17
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2012-0160174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty