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MR. VICTOR LEE ILOG

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
FNP

Contact information

Practice address
6202 ALCHEMY ST, LAS CRUCES, NM 88012-0850
(575) 520-2824
Mailing address
6202 ALCHEMY ST, LAS CRUCES, NM 88012-0850
(575) 520-2824

Taxonomy

Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
G-1916
NM
363LF0000X
Family Nurse Practitioner
AP136515
TX
363LF0000X
Family Nurse Practitioner
CNP-03539
NM
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP136515
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
CNP-03539
NM

Other

Enumeration date
02/12/2018
Last updated
04/13/2026
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