MEDICARE: ALMA ALICIA CARRANZA MS CCC-SLP

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	235Z00000X	Speech-Language Pathologist	SLP6990	NM

General Provider Information

NPI Number	:	1447885850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALMA ALICIA CARRANZA MS CCC-SLP

Provider Business Mailing Address
First Line	:	PO BOX 25704
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87125-0704
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4725 CANDELARIA RD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-1818
Country	:	US
Telephone Number	:	505-888-4033
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2020
Last Update Date	:	03/05/2020

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