Healthcare Provider Details

I. General information

NPI: 1447118476
Provider Name (Legal Business Name): COREY DEAN WARNER CPSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

5901 ZUNI RD SE
ALBUQUERQUE NM
87108-3073
US

IV. Provider business mailing address

300 TIJERAS AVE NE APT 301
ALBUQUERQUE NM
87102-4484
US

V. Phone/Fax

Practice location:
  • Phone: 505-260-7645
  • Fax:
Mailing address:
  • Phone: 505-260-7645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number1794
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: