Organization
ELITE AESTHETICS
Active
Other names
Elite Dermatology
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTIN AUTRY (MANAGER)
(707) 770-9990
Entity
Organization
Contact information
Practice address
1005 S TELSHOR BLVD STE A, LAS CRUCES, NM 88011-4879
(575) 262-7546
(575) 888-2273
Mailing address
PO BOX 871, LAS CRUCES, NM 88004-0871
(409) 719-8846
(575) 888-2273
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10222880
—
NM
Enumeration date
08/12/2019
Last updated
12/30/2024
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