Provider Demographics
NPI:1619974763
Name:DR. BRIAN DELAHOUSSAYE
Entity Type:Organization
Organization Name:DR. BRIAN DELAHOUSSAYE
Other - Org Name:REHABILIATION AND OCCUPATIONAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:R
Authorized Official - Last Name:METCALFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-532-6054
Mailing Address - Street 1:PO BOX 1420
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88004-1420
Mailing Address - Country:US
Mailing Address - Phone:505-532-6054
Mailing Address - Fax:505-532-0512
Practice Address - Street 1:3530 FOOTHILLS RD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-3621
Practice Address - Country:US
Practice Address - Phone:505-532-6054
Practice Address - Fax:505-532-0215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization