Healthcare Provider Details

I. General information

NPI: 1134023062
Provider Name (Legal Business Name): ADELENA MARIE ATENCIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 RIDGEWAY PL
FARMINGTON NM
87401-2092
US

IV. Provider business mailing address

1009 RIDGEWAY PL
FARMINGTON NM
87401-2092
US

V. Phone/Fax

Practice location:
  • Phone: 505-402-6886
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: