Healthcare Provider Details

I. General information

NPI: 1083376131
Provider Name (Legal Business Name): UZI BROSHI DN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 HICKOX ST STE G
SANTA FE NM
87505-1088
US

IV. Provider business mailing address

1114 HICKOX ST STE G
SANTA FE NM
87505-1088
US

V. Phone/Fax

Practice location:
  • Phone: 505-595-7144
  • Fax: 505-444-6455
Mailing address:
  • Phone: 505-595-7144
  • Fax: 505-444-6455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172P00000X
TaxonomyNaprapath
License Number01048
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: