Basic Information
| Provider Information | |||||||||
| NPI: | 1194051797 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TENORIO | ||||||||
| FirstName: | DARLA | ||||||||
| MiddleName: | RAE | ||||||||
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| Credential: | LBSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3695 HOT SPRINGS BLVD | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NM | ||||||||
| PostalCode: | 877019549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5054542100 | ||||||||
| FaxNumber: | 5054540397 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 FRIEDMAN AVE | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NM | ||||||||
| PostalCode: | 877014231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5054545100 | ||||||||
| FaxNumber: | 5054540397 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2009 | ||||||||
| LastUpdateDate: | 11/02/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | B-07141 | NM | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.