Provider Demographics
NPI:1821133042
Name:CARREON, FERNANDO (BA)
Entity Type:Individual
Prefix:MR
First Name:FERNANDO
Middle Name:
Last Name:CARREON
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 HERDNER RD
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-5213
Mailing Address - Country:US
Mailing Address - Phone:505-751-1971
Mailing Address - Fax:
Practice Address - Street 1:413 SIPAPU
Practice Address - Street 2:BOX 6952
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6489
Practice Address - Country:US
Practice Address - Phone:505-758-1596
Practice Address - Fax:505-758-2832
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist