Organization
GABA LLC
Active
Organization
GABA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN A. MOORE CRNA (PRESIDENT)
(575) 532-7000
Entity
Organization
Contact information
Practice address
1313 E 32ND ST, SILVER CITY, NM 88061-7251
(575) 538-4000
Mailing address
205 W BOUTZ RD BLDG 1, LAS CRUCES, NM 88005-3259
(575) 532-7000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10425535
—
NM
01
—
DF2100
RR MEDICARE
—
Enumeration date
08/23/2006
Last updated
06/30/2009
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