Organization Name: | PECOS VALLEY OF NEW MEXICO, LLC |
NPI Number: | 1194781021 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DEBBIE T BREWER (DIRECTOR) |
Mailing Address: | 2430 W Pierce St Carlsbad |
State: | NM US |
Postal Code: | 882203553 |
Phone Number: | 5056283244 |
Fax Number: | |
NPI Enumeration Date: | 04/20/2006 |
NPI Last Update Date: | 02/25/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |