Individual
CARLOS ANDRES RUEDA MANTILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3821 MASTHEAD ST NE, ALBUQUERQUE, NM 87109
(505) 998-7400
(505) 998-7741
Mailing address
3821 MASTHEAD ST NE, ALBUQUERQUE, NM 87109-4679
(312) 826-1105
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
125075440
IL
207RN0300X
Nephrology Physician
Primary
MD2025-0400
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7S1691
MEDICARE
NM
Enumeration date
08/07/2020
Last updated
08/01/2025
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