MEDICARE: CORRALES PRIMARY CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1295693430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORRALES PRIMARY CARE LLC

Provider Business Mailing Address
First Line	:	10301 COTTONWOOD PARK NW STE C
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-7035
Country	:	US
Telephone Number	:	505-871-3863
Fax Number	:	505-447-2371

Provider Business Practice Location Address
First Line	:	10301 COTTONWOOD PARK NW STE C
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-7035
Country	:	US
Telephone Number	:	505-871-3863
Fax Number	:	505-447-2371

Authorized Official
Title or Position	:	OWNER
Name	:	JILLIAN RUSHING
Credential	:	MD
Telephone Number	:	505-871-3863

Provider Enumeration Date	:	01/15/2026
Last Update Date	:	01/15/2026

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