Healthcare Provider Details

I. General information

NPI: 1700588795
Provider Name (Legal Business Name): GABRIEL ALEJANDRO CARSILLO FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 LA BAJADA CT NW
ALBUQUERQUE NM
87105-1513
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 415-305-6374
  • Fax:
Mailing address:
  • Phone: 505-272-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number59679
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: