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Individual

ANGELIQUE CARRILLO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1900 HOT SPRINGS BLVD, LAS VEGAS, NM 87701-3481
(505) 273-4668
Mailing address
PO BOX 94508, ALBUQUERQUE, NM 87199-4508
(575) 733-0003

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary

Other

Enumeration date
04/21/2020
Last updated
04/21/2020
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