Provider Demographics
NPI:1750709473
Name:OLGUIN, JOSE ANJEL
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ANJEL
Last Name:OLGUIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOE
Other - Middle Name:ANJEL
Other - Last Name:OLGUIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:385 CALLE DE ALEGRA
Mailing Address - Street 2:STE A
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005
Mailing Address - Country:US
Mailing Address - Phone:575-526-1105
Mailing Address - Fax:575-524-4266
Practice Address - Street 1:880 E. IDAHO AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001
Practice Address - Country:US
Practice Address - Phone:575-527-7910
Practice Address - Fax:575-527-4457
Is Sole Proprietor?:No
Enumeration Date:2014-03-31
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM18677037Medicaid
NM74481Medicaid