Provider Demographics
NPI:1639845779
Name:SOTO TENA, ANEL NOHELI
Entity Type:Individual
Prefix:
First Name:ANEL
Middle Name:NOHELI
Last Name:SOTO TENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12B LOS CIELOS LN
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-8533
Mailing Address - Country:US
Mailing Address - Phone:505-544-1800
Mailing Address - Fax:
Practice Address - Street 1:4001 OFFICE COURT DR STE 706
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4958
Practice Address - Country:US
Practice Address - Phone:505-544-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM513243189106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician