Healthcare Provider Details

I. General information

NPI: 1437840345
Provider Name (Legal Business Name): TRANQUILINA THERAPEUTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2023
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 CARLISLE BLVD NE STE 201D201E
ALBUQUERQUE NM
87110-5660
US

IV. Provider business mailing address

PO BOX 11605
ALBUQUERQUE NM
87192-0605
US

V. Phone/Fax

Practice location:
  • Phone: 505-226-2937
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: FERNANDO ORTIZ
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 575-707-8150