Healthcare Provider Details

I. General information

NPI: 1437332368
Provider Name (Legal Business Name): DELFINIA S FUENTES LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 07/03/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4704 MARBELLA DR NW
ALBUQUERQUE NM
87120-4666
US

IV. Provider business mailing address

4704 MARBELLA DR NW
ALBUQUERQUE NM
87120-4666
US

V. Phone/Fax

Practice location:
  • Phone: 505-307-4775
  • Fax:
Mailing address:
  • Phone: 505-235-4221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0186741
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: