Individual
MRS. DEBERA CARLTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSR
Contact information
Practice address
428 SOUTH LOS LENTES RD, 428 SOUTH LOS LENTES RD, LOS LUNAS, NM 87031
(505) 865-3350
(505) 865-4739
Mailing address
428 SOUTH LOS LENTES RD., LOS LUNAS, NM 87031-0518
(505) 865-3350
(505) 865-4739
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
850294695
TAX ID
NM
Enumeration date
09/16/2009
Last updated
03/22/2016
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