Healthcare Provider Details

I. General information

NPI: 1922759216
Provider Name (Legal Business Name): DR. TESIA BUSZKIEWICZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 CENTRAL AVE NW # 2
ALBUQUERQUE NM
87104-1143
US

IV. Provider business mailing address

1101 DR MARTIN LUTHER KING JR AVE NE APT 8
ALBUQUERQUE NM
87106-4367
US

V. Phone/Fax

Practice location:
  • Phone: 505-247-4141
  • Fax: 505-843-6249
Mailing address:
  • Phone: 505-252-7428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00009609
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: