Healthcare Provider Details

I. General information

NPI: 1992046031
Provider Name (Legal Business Name): HOPE A CARREON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 MONTANA AVE SUITE B
LAS CRUCES NM
88001-4294
US

IV. Provider business mailing address

PO BOX 2714
LAS CRUCES NM
88004-2714
US

V. Phone/Fax

Practice location:
  • Phone: 575-642-9202
  • Fax:
Mailing address:
  • Phone: 575-642-9202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number5179
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: