Healthcare Provider Details

I. General information

NPI: 1174430482
Provider Name (Legal Business Name): PENELOPE MIA SALAS-ARTERBURN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 JEFFERSON ST NE
ALBUQUERQUE NM
87113-1733
US

IV. Provider business mailing address

5741 OSUNA RD NE
ALBUQUERQUE NM
87109-2567
US

V. Phone/Fax

Practice location:
  • Phone: 314-834-8010
  • Fax:
Mailing address:
  • Phone: 314-834-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: