Healthcare Provider Details

I. General information

NPI: 1326840489
Provider Name (Legal Business Name): LAURA CARBAJAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 03/27/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 COORS BLVD NW
ALBUQUERQUE NM
87120-1173
US

IV. Provider business mailing address

3810 YELLOWSTONE DR
LAS CRUCES NM
88011-9064
US

V. Phone/Fax

Practice location:
  • Phone: 505-836-4990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPT-2023-2271
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: