Healthcare Provider Details

I. General information

NPI: 1649949595
Provider Name (Legal Business Name): CORINNA CIENFUEGOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 LOU ANDES RD
ANTHONY NM
88021-9105
US

IV. Provider business mailing address

1600 LOU ANDES RD
ANTHONY NM
88021-9105
US

V. Phone/Fax

Practice location:
  • Phone: 575-405-9912
  • Fax:
Mailing address:
  • Phone: 575-405-9912
  • 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: