Healthcare Provider Details

I. General information

NPI: 1003702291
Provider Name (Legal Business Name): TAYLOR RAE BEJCEK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CENTRAL AVE SE
ALBUQUERQUE NM
87106-4930
US

IV. Provider business mailing address

1001 CHAMA ST NE
ALBUQUERQUE NM
87110-7113
US

V. Phone/Fax

Practice location:
  • Phone: 505-321-7870
  • Fax:
Mailing address:
  • Phone: 505-321-7870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC3500X
TaxonomyCardiac Rehabilitation Registered Nurse
License Number58478
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: