Healthcare Provider Details

I. General information

NPI: 1861927543
Provider Name (Legal Business Name): CARMEN KAKISH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6320 RIVERSIDE PLAZA LN NW STE A
ALBUQUERQUE NM
87120-1710
US

IV. Provider business mailing address

6320 RIVERSIDE PLAZA LN NW STE B
ALBUQUERQUE NM
87120-1710
US

V. Phone/Fax

Practice location:
  • Phone: 505-843-6168
  • Fax: 505-890-5933
Mailing address:
  • Phone: 505-843-6168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD2021-0770
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: