Healthcare Provider Details

I. General information

NPI: 1902480239
Provider Name (Legal Business Name): KARLA JANET ITZEP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 PERKINS DR STE B
LAS CRUCES NM
88005-3248
US

IV. Provider business mailing address

301 PERKINS DR STE B
LAS CRUCES NM
88005-3248
US

V. Phone/Fax

Practice location:
  • Phone: 575-526-6682
  • Fax:
Mailing address:
  • Phone: 575-526-6682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB20230013
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: