Healthcare Provider Details

I. General information

NPI: 1831875061
Provider Name (Legal Business Name): TRISTAN MASSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNM PA PROGRAM MSC 09 5040
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

UNM PA PROGRAM MSC 09 5040
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-9864
  • Fax:
Mailing address:
  • Phone: 505-272-9864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: