Provider Demographics
NPI:1366863300
Name:CARRASCO, TEOFILO AGUILAR IV (RN)
Entity Type:Individual
Prefix:MR
First Name:TEOFILO
Middle Name:AGUILAR
Last Name:CARRASCO
Suffix:IV
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 CARVER RD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3544
Mailing Address - Country:US
Mailing Address - Phone:575-527-9575
Mailing Address - Fax:575-527-9746
Practice Address - Street 1:226 CARVER RD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3544
Practice Address - Country:US
Practice Address - Phone:575-527-9575
Practice Address - Fax:575-527-9746
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR64486163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool