Provider Demographics
| NPI: | 1720521859 |
|---|---|
| Name: | INETMED RX2 INC. |
| Entity Type: | Organization |
| Organization Name: | INETMED RX2 INC. |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | COO |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | PATTIJO |
| Authorized Official - Middle Name: | N |
| Authorized Official - Last Name: | VELASQUEZ |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | PHD, MSCP |
| Authorized Official - Phone: | 575-646-6136 |
| Mailing Address - Street 1: | 3655 RESEARCH DRIVE |
| Mailing Address - Street 2: | BUILDING B |
| Mailing Address - City: | LAS CRUCES |
| Mailing Address - State: | NM |
| Mailing Address - Zip Code: | 88003-1239 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 575-646-6136 |
| Mailing Address - Fax: | 888-854-0782 |
| Practice Address - Street 1: | 3655 RESEARCH DRIVE |
| Practice Address - Street 2: | BUILDING A |
| Practice Address - City: | LAS CRUCES |
| Practice Address - State: | NM |
| Practice Address - Zip Code: | 88003-1239 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 575-646-6136 |
| Practice Address - Fax: | 888-854-0782 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2016-11-21 |
| Last Update Date: | 2016-11-21 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 103G00000X, 103TA0400X, 103TB0200X, 103TC0700X, 103TC1900X, 103TC2200X, 103TF0000X, 103TF0200X, 103TH0004X, 103TP0016X, 103TP0814X, 103TP2701X, 103TR0400X, 163WA0400X | ||
| NM | 103TP0016X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 103TP0016X | Behavioral Health & Social Service Providers | Psychologist | Prescribing (Medical) | Group - Multi-Specialty |
| No | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | Group - Multi-Specialty | |
| No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Multi-Specialty |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling | Group - Multi-Specialty |
| No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Multi-Specialty |
| No | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family | Group - Multi-Specialty |
| No | 103TF0200X | Behavioral Health & Social Service Providers | Psychologist | Forensic | Group - Multi-Specialty |
| No | 103TH0004X | Behavioral Health & Social Service Providers | Psychologist | Health | Group - Multi-Specialty |
| No | 103TP0814X | Behavioral Health & Social Service Providers | Psychologist | Psychoanalysis | Group - Multi-Specialty |
| No | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | Group - Multi-Specialty |
| No | 103TR0400X | Behavioral Health & Social Service Providers | Psychologist | Rehabilitation | Group - Multi-Specialty |
| No | 163WA0400X | Nursing Service Providers | Registered Nurse | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
