Healthcare Provider Details

I. General information

NPI: 1003741968
Provider Name (Legal Business Name): NOHEMI CARRILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NOHEMI CARRILLO GURROLA

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 MENAUL BLVD NE
ALBUQUERQUE NM
87112-1273
US

IV. Provider business mailing address

556 HORSESHOE TRL SE
ALBUQUERQUE NM
87123-3553
US

V. Phone/Fax

Practice location:
  • Phone: 505-974-0104
  • Fax:
Mailing address:
  • Phone: 505-933-0630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: