Healthcare Provider Details

I. General information

NPI: 1346162013
Provider Name (Legal Business Name): TALIA CARREON
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: TALIA M TRIMMER

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 JACKIE RD SE
RIO RANCHO NM
87124-6610
US

IV. Provider business mailing address

4025 JACKIE RD SE
RIO RANCHO NM
87124-6610
US

V. Phone/Fax

Practice location:
  • Phone: 505-892-8411
  • Fax: 505-375-4793
Mailing address:
  • Phone:
  • Fax: 505-375-4793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT-2026-0021
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: