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Contact Information

CAROLYN W FAGAN
2954 RODEO PARK DR W
SANTA FE, NM87505-6351
 Phone: 505-424-0131
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physical Therapy

261QP2000X
Indicates primary specialty

NPI Profile & details for CAROLYN W FAGAN · (Female)

NPI Number 1215940994
Status Active
Credentials
Entity Individual
Enumeration date 08/14/2006
Last updated 07/08/2007 - About 19 years ago
Sole proprietor 1 Yes
Identifiers
  • NM License # #456
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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