Individual
DR. FERNANDO J INDACOCHEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4401 E. LOHMAN AVE., SUITE A, LAS CRUCES, NM 88011
(575) 532-9077
(575) 532-9221
Mailing address
4395 ISLETA CT, LAS CRUCES, NM 88011-4297
(304) 902-0443
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD2012-0871
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0107734000
—
WV
Enumeration date
08/03/2005
Last updated
09/22/2020
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