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General NPI Number Information
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NPI Number | 1083578702
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Entity Type | Organization
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Legal Business Name | CARRASCO WELLNESS AND DIABETES CARE LLC
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Dates
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Enumeration Date | 12/16/2025
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 1838 SIRINGO RD
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City | SANTA FE
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State | NM
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Zip | 87505-5773
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Country | US
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Telephone | 303-514-4576
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Fax |
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Provider Business Mailing Address
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Address Line | 1838 SIRINGO RD
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City | SANTA FE
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State | NM
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Zip | 87505-5773
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Country | US
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Telephone | 303-514-4576
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PAULINA C CARRASCO
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Credential | RN CDCES
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Telephone | 303-514-4576
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number |
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License Number State |
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