Healthcare Provider Details

I. General information

NPI: 1962145102
Provider Name (Legal Business Name): TSAINA V MAHLEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: N/A N/A

II. Dates (important events)

Enumeration Date: 04/15/2022
Last Update Date: 04/15/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MSC10 6660, 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
81731-0001
US

IV. Provider business mailing address

MSC10 6660, 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
81731-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2610
  • Fax: 505-272-1300
Mailing address:
  • Phone: 505-272-2610
  • Fax: 505-272-1300

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 StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: