Provider Demographics
NPI:1083376131
Name:BROSHI, UZI (DN)
Entity Type:Individual
Prefix:
First Name:UZI
Middle Name:
Last Name:BROSHI
Suffix:
Gender:M
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 HICKOX ST STE G
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-1088
Mailing Address - Country:US
Mailing Address - Phone:505-595-7144
Mailing Address - Fax:505-444-6455
Practice Address - Street 1:1114 HICKOX ST STE G
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-1088
Practice Address - Country:US
Practice Address - Phone:505-595-7144
Practice Address - Fax:505-444-6455
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM01048172P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172P00000XOther Service ProvidersNaprapath
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM01048OtherNEW MEXICO STATE LICENSE