Provider Demographics
NPI:1639255789
Name:GUSCH, ELENE (DOM)
Entity Type:Individual
Prefix:DR
First Name:ELENE
Middle Name:
Last Name:GUSCH
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:622 ESPANOLA ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-2156
Mailing Address - Country:US
Mailing Address - Phone:505-255-0373
Mailing Address - Fax:505-255-2055
Practice Address - Street 1:457 WASHINGTON ST SE
Practice Address - Street 2:SUITE O
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-2713
Practice Address - Country:US
Practice Address - Phone:505-255-0373
Practice Address - Fax:505-255-2055
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM459171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist