Healthcare Provider Details

I. General information

NPI: 1134748833
Provider Name (Legal Business Name): SACHA CHRISTINE BUSH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 04/13/2020
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 GIBSON BLVD SE STE 11
ALBUQUERQUE NM
87108-5182
US

IV. Provider business mailing address

6134 4TH ST NW APT 72
LOS RANCHOS NM
87107-5354
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-3113
  • Fax: 505-982-2462
Mailing address:
  • Phone: 505-850-4995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-11140
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: