Provider Demographics
NPI:1851309207
Name:TESORERO-TENGCO, MAFALDA (MD)
Entity Type:Individual
Prefix:DR
First Name:MAFALDA
Middle Name:
Last Name:TESORERO-TENGCO
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 1:1733 CURIE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2910
Mailing Address - Country:US
Mailing Address - Phone:915-532-2985
Mailing Address - Fax:915-577-9315
Practice Address - Street 1:1733 CURIE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2910
Practice Address - Country:US
Practice Address - Phone:915-532-2985
Practice Address - Fax:915-577-9315
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA57585208000000X
TXN5430208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7475004Medicaid
NJ5272301Medicaid
NJ7475004Medicaid