Healthcare Provider Details

I. General information

NPI: 1043126113
Provider Name (Legal Business Name): DANA CARRIE ATENCIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 MONTANO RD NW
ALBUQUERQUE NM
87120-5743
US

IV. Provider business mailing address

4201 MONTANO RD NW
ALBUQUERQUE NM
87120-5743
US

V. Phone/Fax

Practice location:
  • Phone: 505-922-4997
  • Fax:
Mailing address:
  • Phone: 505-922-4997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00010511
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: