Active NPI
Mario Gardea
- Occupational Therapist
- Las Cruces, NM
National Provider Identifier
1275955635
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 3090
- Practice address
- 755 S Telshor Blvd Ste 201a
Las Cruces, NM 88011-8680 - Phone
- (575) 556-2103
- NPI assigned
- Jan 20, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 3090 | NM | Primary |
Addresses
Primary practice location
755 S Telshor Blvd Ste 201a
Las Cruces, NM 88011-8680
Mailing address
755 S Telshor Blvd Ste 201a
Las Cruces, NM 88011-8680
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3090 | NM | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1390176000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1390176000000",
"number": "1275955635",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "755 S TELSHOR BLVD STE 201A",
"city": "LAS CRUCES",
"state": "NM",
"postal_code": "880118680"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "755 S TELSHOR BLVD STE 201A",
"city": "LAS CRUCES",
"state": "NM",
"postal_code": "880118680",
"telephone_number": "575-556-2103"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GARDEA",
"first_name": "MARIO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-01-20",
"last_updated": "2014-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NM",
"license": "3090",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Cruces, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.