MEDICARE: CELESTINO RINCON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor	419374	NM

General Provider Information

NPI Number	:	1316828403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CELESTINO RINCON

Provider Business Mailing Address
First Line	:	5930 SANDI LN SW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87105-6071
Country	:	US
Telephone Number	:	505-677-5141
Fax Number	:

Provider Business Practice Location Address
First Line	:	5930 SANDI LN SW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87105-6071
Country	:	US
Telephone Number	:	505-677-5141
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2025
Last Update Date	:	01/13/2026

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Directions to “ CELESTINO RINCON ” Practice Location

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