Provider Demographics
NPI:1750538583
Name:DONA ANA REHABILITATION PHYSICIANS PC
Entity type:Organization
Organization Name:DONA ANA REHABILITATION PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ENCAPERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-647-8366
Mailing Address - Street 1:4441 E LOHMAN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8267
Mailing Address - Country:US
Mailing Address - Phone:575-521-6400
Mailing Address - Fax:575-521-6571
Practice Address - Street 1:4441 E LOHMAN AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8267
Practice Address - Country:US
Practice Address - Phone:575-521-6400
Practice Address - Fax:575-521-6571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-22
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2008-0192208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM61935778Medicaid
NMNMB2156Medicare PIN