Provider Demographics
NPI:1497053706
Name:GOLDENBERG, WARREN (CFNP)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:
Last Name:GOLDENBERG
Suffix:
Gender:M
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CALIENTE RD UNIT B1
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-3104
Mailing Address - Country:US
Mailing Address - Phone:505-216-7772
Mailing Address - Fax:505-557-6699
Practice Address - Street 1:7 CALIENTE RD UNIT B1
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508
Practice Address - Country:US
Practice Address - Phone:505-216-7772
Practice Address - Fax:505-557-6699
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP01761363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMCNP-01761OtherCNP LICENSE