Provider Demographics
NPI:1063687622
Name:TSEWANG, DECHEN WANGMO (MD)
Entity Type:Individual
Prefix:
First Name:DECHEN
Middle Name:WANGMO
Last Name:TSEWANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR5 BOX 446
Mailing Address - Street 2:SANTA CLARA HEALTH CENTER
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-9614
Mailing Address - Country:US
Mailing Address - Phone:505-753-9421
Mailing Address - Fax:505-753-5039
Practice Address - Street 1:RR5 BOX 446
Practice Address - Street 2:SANTA CLARA HEALTH CENTER
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-9614
Practice Address - Country:US
Practice Address - Phone:505-753-9421
Practice Address - Fax:505-753-5039
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2011-0468207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine