Healthcare Provider Details

I. General information

NPI: 1760570170
Provider Name (Legal Business Name): TERESA YVONNE MAKOWSKI PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ACL HOSPITAL IHS DHHS
SAN FIDEL NM
87049
US

IV. Provider business mailing address

PO BOX 130 ACOMA CANONCITO LAGUNA INDIAN HOSPITAL IHS DHHS
SAN FIDEL NM
87049
US

V. Phone/Fax

Practice location:
  • Phone: 505-552-5316
  • Fax: 505-552-5491
Mailing address:
  • Phone: 505-552-5385
  • Fax: 505-552-5490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number368
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: