Provider Demographics
NPI:1588172290
Name:KASBOHM, CECILIA ISOLINA (CNP)
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:ISOLINA
Last Name:KASBOHM
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14232
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88013-4232
Mailing Address - Country:US
Mailing Address - Phone:575-532-5455
Mailing Address - Fax:575-532-5641
Practice Address - Street 1:999 W AMADOR AVE STE A
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2739
Practice Address - Country:US
Practice Address - Phone:575-556-9681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-16
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP03471363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health