Provider Demographics
NPI:1649949595
Name:CIENFUEGOS, CORINNA
Entity type:Individual
Prefix:
First Name:CORINNA
Middle Name:
Last Name:CIENFUEGOS
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 1:1600 LOU ANDES RD
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:NM
Mailing Address - Zip Code:88021-9105
Mailing Address - Country:US
Mailing Address - Phone:575-405-9912
Mailing Address - Fax:
Practice Address - Street 1:1600 LOU ANDES RD
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:NM
Practice Address - Zip Code:88021-9105
Practice Address - Country:US
Practice Address - Phone:575-405-9912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist