Provider Demographics
NPI:1669548848
Name:DELAVEGA, OSVALDO RENE (MD)
Entity type:Individual
Prefix:DR
First Name:OSVALDO
Middle Name:RENE
Last Name:DELAVEGA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:755 S TELSHOR BLVD
Mailing Address - Street 2:SUITE S101
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4688
Mailing Address - Country:US
Mailing Address - Phone:575-521-1575
Mailing Address - Fax:575-521-1940
Practice Address - Street 1:755 S TELSHOR BLVD
Practice Address - Street 2:SUITE S101
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4688
Practice Address - Country:US
Practice Address - Phone:575-521-1575
Practice Address - Fax:575-521-1940
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2016-08-08
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Provider Licenses
StateLicense IDTaxonomies
NM90-31207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM23580Medicaid
NM23580Medicaid