Provider Demographics
NPI:1689480667
Name:AGAPE ANESTHESIA & PERIOPERATIVE
Entity type:Organization
Organization Name:AGAPE ANESTHESIA & PERIOPERATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLGUIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-222-0127
Mailing Address - Street 1:1205 S TELSHOR BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4748
Mailing Address - Country:US
Mailing Address - Phone:575-222-0127
Mailing Address - Fax:575-652-3255
Practice Address - Street 1:1205 S TELSHOR BLVD STE A
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4748
Practice Address - Country:US
Practice Address - Phone:575-222-0127
Practice Address - Fax:575-652-3255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-05
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty