Healthcare Provider Details

I. General information

NPI: 1750917928
Provider Name (Legal Business Name): CAMERON PELLEGRINO PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 CANDELARIA RD NE STE A
ALBUQUERQUE NM
87107-1952
US

IV. Provider business mailing address

10505 COYOTE CANYON PL NW
ALBUQUERQUE NM
87114-5949
US

V. Phone/Fax

Practice location:
  • Phone: 505-999-1488
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number80999
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number87329
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: