Healthcare Provider Details

I. General information

NPI: 1043448574
Provider Name (Legal Business Name): OLIVIA JOYCE TUDOR PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 06/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9524 BENT RD NE
ALBUQUERQUE NM
87109-6394
US

IV. Provider business mailing address

9524 BENT RD NE
ALBUQUERQUE NM
87109-6394
US

V. Phone/Fax

Practice location:
  • Phone: 505-292-3816
  • Fax:
Mailing address:
  • Phone: 505-292-3816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number349
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: