Healthcare Provider Details

I. General information

NPI: 1316895055
Provider Name (Legal Business Name): REGINA IRENE QUINTANA CPSW/CCSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RAE QUINTANA

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4210 MEADOWLARK LN SE
RIO RANCHO NM
87124-1021
US

IV. Provider business mailing address

1117 GIRARD BLVD SE APT 6
ALBUQUERQUE NM
87106-2966
US

V. Phone/Fax

Practice location:
  • Phone: 505-560-9355
  • Fax:
Mailing address:
  • Phone: 505-560-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number2094
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: