Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 1474 | NM |
Y | 103TC0700X | Clinical Psychologist | 1474 | NM |
N | 103G00000X | Clinical Psychologist | 1474 | NM |
N | 103TC0700X | Clinical Psychologist | 1474 | NM |
NPI | 1003337767 |
---|---|
Provider Name | Dr. Michael Carvajal |
First Address | Albuquerque, NM 87106-4375 |
Second Address | Albuquerque, NM 87106-2727 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2017 |
Last Update Date | 03/07/2017 |