Healthcare Provider Details

I. General information

NPI: 1831401017
Provider Name (Legal Business Name): CIELO L BUSCH LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHERYL LYN BUSCH LMT

II. Dates (important events)

Enumeration Date: 07/05/2010
Last Update Date: 07/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 CAMINO DE MONTE REY STE B2
SANTA FE NM
87505-3961
US

IV. Provider business mailing address

70 OLD CANONCITO RD
SANTA FE NM
87508-9578
US

V. Phone/Fax

Practice location:
  • Phone: 505-424-9527
  • Fax:
Mailing address:
  • Phone: 505-231-6936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6657
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: