Healthcare Provider Details

I. General information

NPI: 1194660597
Provider Name (Legal Business Name): CARREL DUTRA ANANFAH BAKOUA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 SAMARITAN DR
LAS CRUCES NM
88001-1170
US

IV. Provider business mailing address

2000 MEGAN CREEK DR
LITTLE ELM TX
75068-5038
US

V. Phone/Fax

Practice location:
  • Phone: 575-800-3181
  • Fax:
Mailing address:
  • Phone: 214-605-6081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: