Individual
MR. ANTHONY PAUL CARRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RI
Contact information
Practice address
125 S. MAIN ST., LAS CRUCES, NM 88001
(575) 647-2817
(575) 647-2898
Mailing address
100 W GRIGGS AVE, LAS CRUCES, NM 88001-1234
(575) 647-2800
(575) 647-2898
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
18677037
—
NM
Enumeration date
03/27/2014
Last updated
02/10/2015
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