Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 2296 | NM |
NPI | 1013925692 |
---|---|
Provider Name | Mr. Mark A Figueroa |
First Address | Las Cruces, NM 88001-5111 |
Second Address | Las Cruces, NM 88001-5111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 16/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
57980713 | (05) | NM |
NM00Q039 | BLUE CROSS BLUE SHEILD (01) | NM |
PROVP12974 | MOLINA HEALTHCARE (01) | NM |