1790196665 NPI number — MISSION HEALTH ALLIANCE LLC

Table of content: DR. AIYASAWMY DAVE DORAIRAJAN MD (NPI 1194144535)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790196665 NPI number — MISSION HEALTH ALLIANCE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MISSION HEALTH ALLIANCE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790196665
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2407 W PICACHO AVE
Provider Second Line Business Mailing Address:
A109
Provider Business Mailing Address City Name:
LAS CRUCES
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88007-4124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-649-5898
Provider Business Mailing Address Fax Number:
575-652-4555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2407 W PICACHO AVE
Provider Second Line Business Practice Location Address:
A109
Provider Business Practice Location Address City Name:
LAS CRUCES
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88007-4124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-649-5898
Provider Business Practice Location Address Fax Number:
575-652-4555
Provider Enumeration Date:
05/14/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FOSTER
Authorized Official First Name:
LOGAN
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
575-649-5898

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)