Basic Information
| Provider Information | |||||||||
| NPI: | 1457594756 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JENSEN | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | CELINA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5339 FEATHER ROCK PL NW | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871144197 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2088690683 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1515 E 20TH ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | FARMINGTON | ||||||||
| State: | NM | ||||||||
| PostalCode: | 874019039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5053266400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2009 | ||||||||
| LastUpdateDate: | 12/09/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD2013-0407 | NM | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 1457594756 | 05 | UT | MEDICAID | 833511 | 05 | AZ | MEDICAID | 55320538 | 05 | CO | MEDICAID |