Healthcare Provider Details

I. General information

NPI: 1275482945
Provider Name (Legal Business Name): KARLA ANTONELLA PADILLA REYNOSO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2026
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N ROADRUNNER PKWY APT 502
LAS CRUCES NM
88011-9053
US

IV. Provider business mailing address

301 N ROADRUNNER PKWY APT 502
LAS CRUCES NM
88011-9053
US

V. Phone/Fax

Practice location:
  • Phone: 432-244-9537
  • Fax:
Mailing address:
  • Phone: 432-244-9537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: