Provider Demographics
NPI:1417230277
Name:MOSELEY-SUAZO, CARMEN RENA (PAC)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:RENA
Last Name:MOSELEY-SUAZO
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
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Mailing Address - Street 1:184 UNSER BLVD
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124
Mailing Address - Country:US
Mailing Address - Phone:505-896-0928
Mailing Address - Fax:505-896-0585
Practice Address - Street 1:933 BRADBURY DR SE
Practice Address - Street 2:SUITE 2222
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4374
Practice Address - Country:US
Practice Address - Phone:505-272-3120
Practice Address - Fax:505-272-8060
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2011-0040363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant