Provider Demographics
NPI:1477804409
Name:LAS CRUCES CANCER CARE LLC
Entity Type:Organization
Organization Name:LAS CRUCES CANCER CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:WASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-521-4601
Mailing Address - Street 1:1180 MALL DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8101
Mailing Address - Country:US
Mailing Address - Phone:575-521-4601
Mailing Address - Fax:
Practice Address - Street 1:1180 MALL DR
Practice Address - Street 2:SUITE B
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8101
Practice Address - Country:US
Practice Address - Phone:575-521-4601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2001-330207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty