Provider Demographics
NPI:1831079417
Name:DUENAS, LIBERTY HAYLA-MARIE
Entity type:Individual
Prefix:MRS
First Name:LIBERTY
Middle Name:HAYLA-MARIE
Last Name:DUENAS
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 1:200 N 1ST ST STE B
Mailing Address - Street 2:
Mailing Address - City:GRANTS
Mailing Address - State:NM
Mailing Address - Zip Code:87020-3905
Mailing Address - Country:US
Mailing Address - Phone:505-218-6383
Mailing Address - Fax:
Practice Address - Street 1:200 N 1ST ST STE B
Practice Address - Street 2:
Practice Address - City:GRANTS
Practice Address - State:NM
Practice Address - Zip Code:87020-3905
Practice Address - Country:US
Practice Address - Phone:505-218-6383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program