Individual
ILDEFONSO CARRERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
10188 SOCORRO RD, EL PASO, TX 79927-2322
(915) 479-1473
(915) 440-3148
Mailing address
230 PVT JUAN GARCIA RD, SOCORRO, TX 79927-1323
(915) 479-1473
(915) 440-3148
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2097261
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1881250215
NPPES
TX
Enumeration date
04/08/2021
Last updated
04/08/2021
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