Healthcare Provider Details

I. General information

NPI: 1225637853
Provider Name (Legal Business Name): CARLA SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2020
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 YALE BLVD SE BLDG F
ALBUQUERQUE NM
87106-4228
US

IV. Provider business mailing address

2301 YALE BLVD SE BLDG F
ALBUQUERQUE NM
87106-4228
US

V. Phone/Fax

Practice location:
  • Phone: 150-527-2703
  • Fax:
Mailing address:
  • Phone: 150-527-2703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: