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Organization
OLIVIA SERNA
Active
Organization
OLIVIA SERNA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OLIVIA SERNA (OWNER)
(505) 541-4409
Entity
Organization
Contact information
Practice address
2500 EL PASEO RD., SUITE B, LAS CRUCES, NM 88001
(575) 541-4409
(575) 541-4452
Mailing address
2500 EL PASEO RD., SUITE B, LAS CRUCES, NM 88001
(575) 541-4409
(575) 541-4452
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
11639
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
61677035
—
NM
01
—
NM00TB93
BLUE CROSS BLUE SHIELD OF NEW MEXICO
NM
Enumeration date
07/28/2006
Last updated
05/06/2021
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