Healthcare Provider Details

I. General information

NPI: 1730439787
Provider Name (Legal Business Name): PATRICIA CARPIO LADAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 HAINES AVE NW
ALBUQUERQUE NM
87102-1226
US

IV. Provider business mailing address

481 SANDIA LOOP
BERNALILLO NM
87004-7076
US

V. Phone/Fax

Practice location:
  • Phone: 505-268-5611
  • Fax: 505-268-5736
Mailing address:
  • Phone: 505-867-4696
  • Fax: 505-867-4997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0125081
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: