Provider Demographics
NPI:1659135093
Name:PADILLA SERNA, CRYSTAL (LMT)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:PADILLA SERNA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N CHURCH ST STE 508
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-3440
Mailing Address - Country:US
Mailing Address - Phone:575-993-9519
Mailing Address - Fax:
Practice Address - Street 1:500 N CHURCH ST STE 508
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3440
Practice Address - Country:US
Practice Address - Phone:575-993-9519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMT-2023-0012225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty