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NPI Code Detail

MEDICARE: DR. TERESA ANN O'BRIEN MD

MEDICARE: DR. TERESA ANN O'BRIEN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician2001-273NM
22084P0804XChild & Adolescent Psychiatry Physician2001-273NM

General Provider Information

NPI Number : 1053349878
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TERESA ANN O'BRIEN MD
Provider Business Mailing Address
First Line : 3695 HOT SPRINGS BLVD
Second Line :
City : LAS VEGAS
State : NM
Zip : 87701-9549
Country : US
Telephone Number : 505-454-2100
Fax Number :
Provider Business Practice Location Address
First Line : 3695 HOT SPRINGS BLVD
Second Line :
City : LAS VEGAS
State : NM
Zip : 87701-9549
Country : US
Telephone Number : 505-454-2100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2006
Last Update Date : 03/07/2019

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