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General NPI Number Information
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NPI Number | 1215757521
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Entity Type | Individual
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Provider Name | XXX TENEBROSO CRISENCIO TAMBIEN REGISTERED NURSE
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Gender | Male
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Dates
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Enumeration Date | 10/11/2024
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | BUFFALO PSYCHIATRIC CENTER 400 FOREST AVENUE
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City | BUFFALO
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State | NY
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Zip | 14213
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Country | US
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Telephone | 716-816-2121
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Fax |
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Provider Business Mailing Address
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Address Line | 36 WILKERSON STREET
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City | THOROLD
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State | ZZ - FOREIGN COUNTRIES
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Zip | L2V0G4
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Country | CA
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | 75917801
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License Number State | NY
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