Healthcare Provider Details

I. General information

NPI: 1194269829
Provider Name (Legal Business Name): VERONICA DIANE PUENTES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2016
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 RENARD PL SE STE 110
ALBUQUERQUE NM
87106-4258
US

IV. Provider business mailing address

2305 RENARD PL SE STE 110
ALBUQUERQUE NM
87106-4258
US

V. Phone/Fax

Practice location:
  • Phone: 505-230-3790
  • Fax:
Mailing address:
  • Phone: 718-215-5311
  • Fax: 505-226-3299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: