Healthcare Provider Details

I. General information

NPI: 1568932465
Provider Name (Legal Business Name): CAROLINE OLIVAS BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2018
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001B EL CENTRO FAMILIAR BLVD SW
ALBUQUERQUE NM
87105-4556
US

IV. Provider business mailing address

2600 MARBLE AVE NE
ALBUQUERQUE NM
87106-2058
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-5786
  • Fax: 505-925-0703
Mailing address:
  • Phone: 505-272-5786
  • Fax: 505-925-0703

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: