Healthcare Provider Details

I. General information

NPI: 1699688242
Provider Name (Legal Business Name): EMILIO JOSEPH CARREON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 S TELSHOR BLVD
LAS CRUCES NM
88011-5076
US

IV. Provider business mailing address

1822 BRIDLE PL
EL PASO TX
79911-4000
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-8641
  • Fax:
Mailing address:
  • Phone: 915-259-7271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number92081
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: