Healthcare Provider Details

I. General information

NPI: 1134857469
Provider Name (Legal Business Name): ANGELIQUE TENORIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2022
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9007 WASHINGTON ST NE
ALBUQUERQUE NM
87113-2722
US

IV. Provider business mailing address

3175 MORRISSEY ST SW
ALBUQUERQUE NM
87121-5472
US

V. Phone/Fax

Practice location:
  • Phone: 505-209-3412
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2025-0980
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: