Healthcare Provider Details

I. General information

NPI: 1750193728
Provider Name (Legal Business Name): CORYANN SENTENO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2025
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 GOLD AVE SW
ALBUQUERQUE NM
87102-3283
US

IV. Provider business mailing address

400 GOLD AVE SW
ALBUQUERQUE NM
87102-3283
US

V. Phone/Fax

Practice location:
  • Phone: 505-715-4610
  • Fax:
Mailing address:
  • Phone: 505-715-4610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPT00004147
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: