Healthcare Provider Details

I. General information

NPI: 1780388512
Provider Name (Legal Business Name): SHANA MARIE VORENBERG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MSC10 5580 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

300 TIJERAS AVE NE APT 408
ALBUQUERQUE NM
87102-4489
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-6385
  • Fax:
Mailing address:
  • Phone: 505-470-6992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: