Provider Demographics
NPI:1407178007
Name:RENAL MEDICINE OF LAS CRUCES LLC
Entity Type:Organization
Organization Name:RENAL MEDICINE OF LAS CRUCES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-521-0008
Mailing Address - Street 1:2930 HILLRISE DR
Mailing Address - Street 2:STE. 5
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4776
Mailing Address - Country:US
Mailing Address - Phone:575-521-0008
Mailing Address - Fax:575-521-0063
Practice Address - Street 1:2930 HILLRISE DR
Practice Address - Street 2:STE. 5
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4776
Practice Address - Country:US
Practice Address - Phone:575-521-0008
Practice Address - Fax:575-521-0063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-23
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2004-0025207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM85430552Medicaid
NMNMB2442Medicare PIN