MEDICARE: MRS. MARTHA MARIE QUINTANA-SERNA PED

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	172V00000X	Community Health Worker	N0047800	NM

General Provider Information

NPI Number	:	1568319564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARTHA MARIE QUINTANA-SERNA PED

Provider Business Mailing Address
First Line	:	PO BOX 305
Second Line	:	313 CUPRITE ST
City	:	TYRONE
State	:	NM
Zip	:	88065-0305
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1107 N POPE ST
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061
Country	:	US
Telephone Number	:	575-597-2415
Fax Number	:	575-313-8236

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

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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