Provider Demographics
NPI:1982918090
Name:GAUDENCIO PAVIA MD LLC
Entity Type:Organization
Organization Name:GAUDENCIO PAVIA MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAUDENCIO
Authorized Official - Middle Name:
Authorized Official - Last Name:PAVIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-647-8366
Mailing Address - Street 1:1180 MALL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8101
Mailing Address - Country:US
Mailing Address - Phone:575-523-4344
Mailing Address - Fax:575-647-8381
Practice Address - Street 1:1180 MALL DR
Practice Address - Street 2:SUITE A
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8101
Practice Address - Country:US
Practice Address - Phone:575-523-4344
Practice Address - Fax:575-647-8381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2003-0735207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty