MEDICARE: DR. PIA ANDREA BUSH PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1548751522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PIA ANDREA BUSH PSYD

Provider Business Mailing Address
First Line	:	701 COAL AVE SW APT 262
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87102-3071
Country	:	US
Telephone Number	:	757-685-2310
Fax Number	:

Provider Business Practice Location Address
First Line	:	4270 S DECATUR BLVD STE A10A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-6801
Country	:	US
Telephone Number	:	702-912-5559
Fax Number	:	702-912-5536

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2018
Last Update Date	:	05/24/2018

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