Healthcare Provider Details

I. General information

NPI: 1316804065
Provider Name (Legal Business Name): ELSA BJORK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IDA BJORK

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 TRAMWAY BLVD NE
ALBUQUERQUE NM
87112-4655
US

IV. Provider business mailing address

1200 MICHAEL HUGHES DR NE
ALBUQUERQUE NM
87112-6311
US

V. Phone/Fax

Practice location:
  • Phone: 505-266-6121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1001476
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: