MEDICARE: GUS CARRILLO M.S.W.

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	104100000X	Social Worker	M-09587	NM

General Provider Information

NPI Number	:	1922457977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUS CARRILLO M.S.W.

Provider Business Mailing Address
First Line	:	4036 RAYADO PL NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-5538
Country	:	US
Telephone Number	:	505-362-3378
Fax Number	:

Provider Business Practice Location Address
First Line	:	4036 RAYADO PL NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-5538
Country	:	US
Telephone Number	:	505-362-3378
Fax Number	:

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

Provider Enumeration Date	:	06/10/2016
Last Update Date	:	06/28/2026

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Directions to “ GUS CARRILLO M.S.W.” Practice Location

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