Jennifer Agosta, MD
Individual provider Active NPI Internal Medicine Physician · Las Cruces, NM
NPI 1174749014 · NPPES record last updated Dec 21, 2017
Key facts
- NPI
- 1174749014
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- MD2008-0157 (NM)
- Practice address
- 4351 E Lohman Ave Ste 320
Las Cruces, NM 88011-8262 - Phone
- (575) 556-3240
- Fax
- (575) 522-3092
- NPI assigned
- Apr 18, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD2008-0157 | NM | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Familycare Associates,PA | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MD2008-0157 | NM | Yes |
Addresses
Primary practice location
4351 E Lohman Ave Ste 320
Las Cruces, NM 88011-8262
Mailing address
4351 E Lohman Ave Ste 320
Las Cruces, NM 88011-8262
Phone (575) 556-3240
Other practice location 1
4351 E Lohman Ave
Suite 409
Las Cruces, NM 88011-8259
Phone (575) 556-3240
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 570315YY54 | Other | NM | MEDICARE ID |
| 29380049 | Medicaid | NM |
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All providers in Las Cruces, NM · Internal Medicine Physician in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 21, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.