Provider Demographics
NPI:1629622055
Name:SOUTHERN NEW MEXICO HEART AND VASCULAR GROUP LLC
Entity Type:Organization
Organization Name:SOUTHERN NEW MEXICO HEART AND VASCULAR GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:CRISTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-532-5838
Mailing Address - Street 1:3865 E LOHMAN AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8292
Mailing Address - Country:US
Mailing Address - Phone:575-532-5838
Mailing Address - Fax:575-532-1778
Practice Address - Street 1:3865 E LOHMAN AVE STE 4
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8292
Practice Address - Country:US
Practice Address - Phone:575-532-5838
Practice Address - Fax:575-532-1778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty