Individual
BRENDA L CARABAJAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
200 W SANTA FE AVE, GRANTS, NM 87020-2530
(505) 287-5483
Mailing address
1831 ALIF RD NE, RIO RANCHO, NM 87144-1586
(505) 879-4802
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
46069
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
616784300
DOL PROVIDER NUMBER
NM
Enumeration date
04/28/2020
Last updated
04/28/2020
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