Healthcare Provider Details

I. General information

NPI: 1720904725
Provider Name (Legal Business Name): ATHENA ISABELLA SERRANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 RIVERSIDE PLAZA LN NW STE 260
ALBUQUERQUE NM
87120-2160
US

IV. Provider business mailing address

6330 RIVERSIDE PLAZA LN NW STE 260
ALBUQUERQUE NM
87120-2160
US

V. Phone/Fax

Practice location:
  • Phone: 505-226-2839
  • Fax: 505-645-7909
Mailing address:
  • Phone: 505-226-2839
  • Fax: 505-645-7909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB20260642
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: