Provider Demographics
NPI:1679617229
Name:CARLOS A CADENA DPM PC
Entity type:Organization
Organization Name:CARLOS A CADENA DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:CADENA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:575-521-0055
Mailing Address - Street 1:2800 DORAL CT STE A
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8616
Mailing Address - Country:US
Mailing Address - Phone:575-521-0055
Mailing Address - Fax:575-521-0077
Practice Address - Street 1:2800 DORAL CT STE A
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8616
Practice Address - Country:US
Practice Address - Phone:575-521-0055
Practice Address - Fax:575-521-0077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM238213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM005399OtherBLUE CROSS BLUE SHIELD
NM000H1034Medicaid
NM005399OtherBLUE CROSS BLUE SHIELD
NM000H1034Medicaid