Healthcare Provider Details

I. General information

NPI: 1609788942
Provider Name (Legal Business Name): KARLA JANNETH FAVELA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 8069
ALBUQUERQUE NM
87198-8069
US

IV. Provider business mailing address

12250 TIERRA BUENA DR
EL PASO TX
79938-4466
US

V. Phone/Fax

Practice location:
  • Phone: 505-633-8173
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: