Provider Demographics
NPI:1891808077
Name:MESILLA VALLEY SLEEP LAB, LLC
Entity Type:Organization
Organization Name:MESILLA VALLEY SLEEP LAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLININCAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMORA
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:575-647-5337
Mailing Address - Street 1:1155 COMMERCE DR STE G
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8257
Mailing Address - Country:US
Mailing Address - Phone:575-647-5337
Mailing Address - Fax:575-647-5338
Practice Address - Street 1:1155 COMMERCE DR
Practice Address - Street 2:SUITE G
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8257
Practice Address - Country:US
Practice Address - Phone:575-532-7000
Practice Address - Fax:575-532-7006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00NM007G71OtherBLUE CROSS BLUE SHIELD
NM95316OtherPRESBYTERIAN HEALTH PLAN
NM=========OtherMOLINA HEALTH CARE
NM500521048Medicare ID - Type UnspecifiedMEDICARE