Healthcare Provider Details

I. General information

NPI: 1063340099
Provider Name (Legal Business Name): YESENIA PEDROZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: YESENIA BELTRAN

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ADDRESS: 7027 MONTGOMERY BLVD NE SUITE F
ALBUQUERQUE NM
87109
US

IV. Provider business mailing address

417 DARTMOUTH DR SE
ALBUQUERQUE NM
87106-2288
US

V. Phone/Fax

Practice location:
  • Phone: 505-480-7573
  • Fax:
Mailing address:
  • Phone: 505-480-7573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCMH0120641
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: