Healthcare Provider Details

I. General information

NPI: 1538024377
Provider Name (Legal Business Name): ESTELA TENORIO-THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 CAMINO DE VIDA STE 100
SANTA ROSA NM
88435-2267
US

IV. Provider business mailing address

117 CAMINO DE VIDA STE 100
SANTA ROSA NM
88435-2267
US

V. Phone/Fax

Practice location:
  • Phone: 575-472-3417
  • Fax: 575-541-3649
Mailing address:
  • Phone: 575-472-3417
  • Fax: 575-541-3649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberG-1942
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: