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General NPI Number Information
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NPI Number | 1467593764
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Entity Type | Organization
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Legal Business Name | CARLACARE, INC.
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 945 ROSALIE AVE
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City | LAS CRUCES
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State | NM
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Zip | 88005-0938
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Country | US
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Telephone | 505-524-3967
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Fax |
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Provider Business Mailing Address
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Address Line | 1988 CRESCENT DR
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City | LAS CRUCES
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State | NM
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Zip | 88005-3323
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Country | US
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Telephone | 505-524-3735
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. RICHARD B. CARRILLO
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Credential |
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Telephone | 505-524-3735
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | D3656
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License Number State | NM
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