Organization
FAMILY PRACTICE MEDICAL AND DIETETIC MEDICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSE ROSALES NP (OWNER)
(575) 532-5386
Entity
Organization
Contact information
Practice address
2904 HILLRISE DR, LAS CRUCES, NM 88011-4702
(575) 532-5386
(575) 532-5449
Mailing address
2904 HILLRISE DR, LAS CRUCES, NM 88011-4702
(575) 532-5386
(575) 532-5449
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
DT06119
TX
133V00000X
Registered Dietitian
LD0748
NM
363LP2300X
Primary Care Nurse Practitioner
Primary
CNP00942
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1609199447
BCBS
NM
05
—
58878335
—
NM
Enumeration date
03/08/2010
Last updated
03/29/2013
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