Healthcare Provider Details

I. General information

NPI: 1760208664
Provider Name (Legal Business Name): MAIRA TENA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4004 CARLISLE BLVD NE STE B
ALBUQUERQUE NM
87107-4566
US

IV. Provider business mailing address

4004 CARLISLE BLVD NE STE B
ALBUQUERQUE NM
87107-4566
US

V. Phone/Fax

Practice location:
  • Phone: 505-585-5024
  • Fax:
Mailing address:
  • Phone: 505-585-5024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: