Healthcare Provider Details

I. General information

NPI: 1093228785
Provider Name (Legal Business Name): NAOMI TENA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2017
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 LOS LENTES RD SE STE 3
LOS LUNAS NM
87031-6018
US

IV. Provider business mailing address

1121 COTTONWOOD CT SE
LOS LUNAS NM
87031-6895
US

V. Phone/Fax

Practice location:
  • Phone: 505-865-3350
  • Fax:
Mailing address:
  • Phone: 505-610-9674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCMH0219041
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: