Provider Demographics
NPI:1518794320
Name:LICANO, XIMENA
Entity type:Individual
Prefix:
First Name:XIMENA
Middle Name:
Last Name:LICANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 SAINT FRANCIS CT
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-9381
Mailing Address - Country:US
Mailing Address - Phone:575-652-2743
Mailing Address - Fax:
Practice Address - Street 1:2201 SAINT FRANCIS CT
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-9381
Practice Address - Country:US
Practice Address - Phone:575-652-2743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula