Healthcare Provider Details

I. General information

NPI: 1659601235
Provider Name (Legal Business Name): THRESA NOLESZENSKI MALDONADO LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: THRESA NOLESZENSKI CORONA LMT

II. Dates (important events)

Enumeration Date: 01/05/2010
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 COMANCHE RD NE SUITE E-22
ALBUQUERQUE NM
87107-4546
US

IV. Provider business mailing address

3500 COMANCHE RD NE SUITE E-22
ALBUQUERQUE NM
87107-4546
US

V. Phone/Fax

Practice location:
  • Phone: 505-615-0597
  • Fax:
Mailing address:
  • Phone: 505-615-0597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number6477
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: