Provider Demographics
NPI:1669084422
Name:BURCIAGA-TENA, ESTEBAN (PHARMD)
Entity type:Individual
Prefix:
First Name:ESTEBAN
Middle Name:
Last Name:BURCIAGA-TENA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:ESTEBAN
Other - Middle Name:
Other - Last Name:BURCIAGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:7004 DONA ANGELICA AVE SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-3574
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1201 UNSER BLVD SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-8315
Practice Address - Country:US
Practice Address - Phone:505-831-5094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00009343183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist