Basic Information
| Provider Information | |||||||||
| NPI: | 1750538583 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DONA ANA REHABILITATION PHYSICIANS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4441 E LOHMAN AVE | ||||||||
| Address2: | |||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880118267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5755216400 | ||||||||
| FaxNumber: | 5755216571 | ||||||||
| Practice Location | |||||||||
| Address1: | 4441 E LOHMAN AVE | ||||||||
| Address2: | |||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880118267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5755216400 | ||||||||
| FaxNumber: | 5755216571 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2008 | ||||||||
| LastUpdateDate: | 03/09/2009 | ||||||||
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| AuthorizedOfficialLastName: | ENCAPERA | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLY | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | MD/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5756478366 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | MD2008-0192 | NM | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 61935778 | 05 | NM | MEDICAID |