Healthcare Provider Details

I. General information

NPI: 1144624701
Provider Name (Legal Business Name): LORENA SIFUENTEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2014
Last Update Date: 10/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 SAN MATEO BLVD NE
ALBUQUERQUE NM
87110-3165
US

IV. Provider business mailing address

912 PACIFIC AVE SW
ALBUQUERQUE NM
87102-4060
US

V. Phone/Fax

Practice location:
  • Phone: 505-888-4044
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: