Healthcare Provider Details

I. General information

NPI: 1508883232
Provider Name (Legal Business Name): WILHELMINA FRANCISCO TENGCO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 12/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6747 ACADEMY RD NE STE A
ALBUQUERQUE NM
87109
US

IV. Provider business mailing address

6747 ACADEMY RD NE STE A
ALBUQUERQUE NM
87109-3374
US

V. Phone/Fax

Practice location:
  • Phone: 505-880-1120
  • Fax: 505-881-6955
Mailing address:
  • Phone: 505-880-1120
  • Fax: 505-881-6955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number83319
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: