Individual
MR. CARL LEE WAMBOLDT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1001 WEST BROADWAY, FARMINGTON, NM 87401-5638
(505) 327-4796
Mailing address
1001 W BROADWAY STE D, FARMINGTON, NM 87401-5638
(505) 327-4796
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
SWB-2025-0085
NM
171M00000X
Case Manager/Care Coordinator
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/02/2017
Last updated
03/06/2025
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