Healthcare Provider Details

I. General information

NPI: 1710632211
Provider Name (Legal Business Name): CARLOS AARON OLIVAS PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2022
Last Update Date: 03/04/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 N 13TH ST
ARTESIA NM
88210-1199
US

IV. Provider business mailing address

3525 MOREHEAD AVE
EL PASO TX
79930-5515
US

V. Phone/Fax

Practice location:
  • Phone: 575-748-3333
  • Fax: 575-748-8540
Mailing address:
  • Phone: 915-267-0218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number66207
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: