Most Relevant Information
Provider Data
| NPI Number: | 1003004359 |
| Provider Name: | JEREMY JAMES BALDILLEZ |
| Entity Type: | Individual |
| Taxonomy Code: | 103TS0200X |
| Specialty: | Psychologist |
| License Number: | 275299 |
Most Important Dates
| Enumeration Date: | 10/11/2007 |
| Last Updated: | 04/21/2017 |
Provider Practice Location
3100 OAK ST
LAS CRUCES
NM
880053425
Practice Location Phone/Fax
| Phone: | 5753233354 |
| Fax: | 5755233354 |
Provider Mailing Location
505 S MAIN ST
STE 249
LAS CRUCES
NM
880011206
Provider Mailing Phone/Fax
| Phone: | 5055275823 |
| Fax: | 5055275886 |