Individual
XYTLALLI JESENIA REYES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1320 S SOLANO DR, LAS CRUCES, NM 88001-3758
(575) 522-4004
Mailing address
4790 NORTHGATE RD, LAS CRUCES, NM 88012-9572
(575) 635-3474
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10215562800
—
NM
Enumeration date
07/28/2022
Last updated
07/28/2022
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