Healthcare Provider Details

I. General information

NPI: 1346933678
Provider Name (Legal Business Name): SIPHEPHILE MOYO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2023
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 CONSTITUTION AVE NE
ALBUQUERQUE NM
87110-7513
US

IV. Provider business mailing address

6305 ALPENGLOW TRL NE
ALBUQUERQUE NM
87113-3402
US

V. Phone/Fax

Practice location:
  • Phone: 505-296-5565
  • Fax:
Mailing address:
  • Phone: 714-713-5488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License Number87593
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: