Healthcare Provider Details

I. General information

NPI: 1083578702
Provider Name (Legal Business Name): CARRASCO WELLNESS AND DIABETES CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1838 SIRINGO RD
SANTA FE NM
87505-5773
US

IV. Provider business mailing address

1838 SIRINGO RD
SANTA FE NM
87505-5773
US

V. Phone/Fax

Practice location:
  • Phone: 303-514-4576
  • Fax:
Mailing address:
  • Phone: 303-514-4576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: PAULINA C CARRASCO
Title or Position: OWNER
Credential: RN CDCES
Phone: 303-514-4576