Healthcare Provider Details

I. General information

NPI: 1063297539
Provider Name (Legal Business Name): CARMELA ESQUIBEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 04/30/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87109-1219
US

IV. Provider business mailing address

4701 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87109-1219
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-6853
  • Fax:
Mailing address:
  • Phone: 505-727-6853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number75439
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number75439
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number75439
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: