Healthcare Provider Details

I. General information

NPI: 1295693430
Provider Name (Legal Business Name): CORRALES PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2026
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10301 COTTONWOOD PARK NW
ALBUQUERQUE NM
87114-7035
US

IV. Provider business mailing address

10301 COTTONWOOD PARK NW
ALBUQUERQUE NM
87114-7035
US

V. Phone/Fax

Practice location:
  • Phone: 505-871-3863
  • Fax: 505-447-2371
Mailing address:
  • Phone: 505-871-3863
  • Fax: 505-447-2371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JILLIAN RUSHING
Title or Position: OWNER
Credential: MD
Phone: 505-871-3863