Healthcare Provider Details

I. General information

NPI: 1346073244
Provider Name (Legal Business Name): CONSEULO ELISA PINEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 08/26/2024
Certification Date: 08/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 S SAINT FRANCIS DR
SANTA FE NM
87505-4038
US

IV. Provider business mailing address

25C PASEO NOPAL
SANTA FE NM
87507-8624
US

V. Phone/Fax

Practice location:
  • Phone: 505-690-2833
  • Fax:
Mailing address:
  • Phone: 505-690-2833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLMT-2024-0170
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: