Provider Demographics
NPI:1568542801
Name:TAPIA, CARL (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:TAPIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4420 IRVING BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5915
Mailing Address - Country:US
Mailing Address - Phone:505-727-6300
Mailing Address - Fax:505-727-9588
Practice Address - Street 1:4420 IRVING BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5915
Practice Address - Country:US
Practice Address - Phone:505-727-6300
Practice Address - Fax:505-727-9588
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2018-0464208000000X
TXM2485208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM36478725Medicaid
TX179029701Medicaid
TX179029701Medicaid