Provider Demographics
NPI:1942847462
Name:BANEGAS-CARREON, LUCINDA (MPH, CHES)
Entity Type:Individual
Prefix:
First Name:LUCINDA
Middle Name:
Last Name:BANEGAS-CARREON
Suffix:
Gender:F
Credentials:MPH, CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30003
Mailing Address - Street 2:MSC 3AE
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88003
Mailing Address - Country:US
Mailing Address - Phone:575-646-2034
Mailing Address - Fax:
Practice Address - Street 1:940 COLLEGE DR.
Practice Address - Street 2:CORNER OF KNOX AND COLLEGE
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88003
Practice Address - Country:US
Practice Address - Phone:575-646-2034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator