Basic Information
| Provider Information | |||||||||
| NPI: | 1881760957 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAVIA | ||||||||
| FirstName: | GAUDENCIO | ||||||||
| MiddleName: | ORTIZ | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1560 | ||||||||
| Address2: | |||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880041560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5756478366 | ||||||||
| FaxNumber: | 5756478381 | ||||||||
| Practice Location | |||||||||
| Address1: | 1180 MALL DR | ||||||||
| Address2: | #A | ||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880118101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5055234344 | ||||||||
| FaxNumber: | 5056478381 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2006 | ||||||||
| LastUpdateDate: | 06/24/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD2003-0735 | NM | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.