Healthcare Provider Details

I. General information

NPI: 1316828403
Provider Name (Legal Business Name): CELESTINO RINCON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 01/13/2026
Certification Date: 01/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5930 SANDI LN SW
ALBUQUERQUE NM
87105-6071
US

IV. Provider business mailing address

5930 SANDI LN SW
ALBUQUERQUE NM
87105-6071
US

V. Phone/Fax

Practice location:
  • Phone: 505-677-5141
  • Fax:
Mailing address:
  • Phone: 505-677-5141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number419374
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: