1902170160 NPI number — SELENA R SAVELL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902170160 NPI number — SELENA R SAVELL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAVELL
Provider First Name:
SELENA
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FLOREZ
Provider Other First Name:
SELENA
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1902170160
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
215 W BROADWAY ST STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOBBS
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88240-6075
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-433-2211
Provider Business Mailing Address Fax Number:
575-433-4211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 W BROADWAY ST STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOBBS
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88240-6075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-433-2211
Provider Business Practice Location Address Fax Number:
575-433-4211
Provider Enumeration Date:
03/05/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: CCMH0224461 , 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)

  • Identifier: 83725873 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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