Healthcare Provider Details

I. General information

NPI: 1417891839
Provider Name (Legal Business Name): MONICA PRUNEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 MARBLE AVE NE
ALBUQUERQUE NM
87106-2058
US

IV. Provider business mailing address

9180 COORS BLVD NW APT 3205
ALBUQUERQUE NM
87120-3176
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-5935
  • Fax: 505-272-5395
Mailing address:
  • Phone: 559-690-8704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: