Provider Demographics
NPI:1316982366
Name:PAZ, CONCHITA M (MD)
Entity type:Individual
Prefix:DR
First Name:CONCHITA
Middle Name:M
Last Name:PAZ
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1135 S MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-2946
Mailing Address - Country:US
Mailing Address - Phone:575-525-4000
Mailing Address - Fax:575-525-4040
Practice Address - Street 1:1135 S MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2946
Practice Address - Country:US
Practice Address - Phone:575-525-4000
Practice Address - Fax:575-525-4040
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2020-09-09
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Provider Licenses
StateLicense IDTaxonomies
NM85263207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00036202Medicaid
NMNM300005Medicare PIN
NM00036202Medicaid