Provider Demographics
NPI:1083090419
Name:CARMEN BROWN LLC
Entity Type:Organization
Organization Name:CARMEN BROWN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RODICA
Authorized Official - Middle Name:CARMEN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:505-304-4248
Mailing Address - Street 1:10409 MANZANILLO AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1724
Mailing Address - Country:US
Mailing Address - Phone:505-304-4248
Mailing Address - Fax:
Practice Address - Street 1:10409 MANZANILLO AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1724
Practice Address - Country:US
Practice Address - Phone:505-304-4248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2002-0030207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty