MEDICARE: ANDRIA C ARELLANO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician
2	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1639782246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDRIA C ARELLANO

Provider Business Mailing Address
First Line	:	PO BOX 28164
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87592-8164
Country	:	US
Telephone Number	:	505-216-2727
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 THE AMERICAN RD SE STE 100
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87124-1858
Country	:	US
Telephone Number	:	505-404-6907
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2020
Last Update Date	:	08/08/2025

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Directions to “ ANDRIA C ARELLANO ” Practice Location

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