Healthcare Provider Details

I. General information

NPI: 1467593764
Provider Name (Legal Business Name): CARLACARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 ROSALIE AVE
LAS CRUCES NM
88005-0938
US

IV. Provider business mailing address

1988 CRESCENT DR
LAS CRUCES NM
88005-3323
US

V. Phone/Fax

Practice location:
  • Phone: 505-524-3967
  • Fax:
Mailing address:
  • Phone: 505-524-3735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD3656
License Number StateNM

VIII. Authorized Official

Name: MR. RICHARD B. CARRILLO
Title or Position: DIRECTOR
Credential:
Phone: 505-524-3735