Individual
MARY CARRILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
435 BLUETHORN CT SW, ALBUQUERQUE, NM 87121-9331
(505) 440-3144
Mailing address
435 BLUETHORN CT SW, ALBUQUERQUE, NM 87121-9331
(505) 440-3144
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
08/17/2020
Last updated
08/17/2020
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