Provider Demographics
NPI:1881812352
Name:THE PROFESSIONAL ASSESSMENT CENTER
Entity type:Organization
Organization Name:THE PROFESSIONAL ASSESSMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:ISRAEL
Authorized Official - Last Name:AGUILAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-307-1535
Mailing Address - Street 1:1100 S MAIN ST
Mailing Address - Street 2:BLDG B STE 20
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-2917
Mailing Address - Country:US
Mailing Address - Phone:505-525-5635
Mailing Address - Fax:505-647-8804
Practice Address - Street 1:1100 S MAIN ST
Practice Address - Street 2:BLDG B STE 20
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2917
Practice Address - Country:US
Practice Address - Phone:505-525-5635
Practice Address - Fax:505-647-8804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMN2484Medicaid