Healthcare Provider Details

I. General information

NPI: 1720229362
Provider Name (Legal Business Name): JUANITA SENA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2009
Last Update Date: 03/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

01 SAGEBRUSH ROAD
ISLETA NM
87022-0580
US

IV. Provider business mailing address

01 SAGEBRUSH ROAD
ISLETA NM
87022-0580
US

V. Phone/Fax

Practice location:
  • Phone: 505-869-3200
  • Fax: 505-869-4584
Mailing address:
  • Phone: 505-869-3200
  • Fax: 505-869-4584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR12755
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: