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Carlos Andres Rueda Mantilla

Internal Medicine

Allopathic & Osteopathic Physicians

3821 Masthead St NE, Albuquerque, NM 87109

PECOS Enrollment

This provider is enrolled in PECOS as CARLOS RUEDA MANTILLA.

Based on the most recent information from CMS, provider Carlos Andres Rueda Mantilla is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 5 days ago.

Profile Details

Provider ID
1003426743
Provider Type
Individual
Full Name
Rueda Mantilla, Carlos Andres
Credential
MD

Gender
Male
Sole Proprietor
No
Enumeration Date
8/7/2020
Last Updated
6/23/2025

Contact Information

Practice Location

3821 Masthead St NE, Albuquerque, NM 87109

(505) 998-7400

(505) 998-7741

Mailing Location

3821 Masthead St NE, Albuquerque, NM 87109-4679

(312) 826-1105

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License 125075440 Illinois
Code 207RN0300X	Description Internal Medicine Allopathic & Osteopathic Physicians	License MD2025-0400 New Mexico

Carlos Andres Rueda Mantilla

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

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Description

License

Code

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Code

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