Provider Demographics
NPI:1831401017
Name:BUSCH, CIELO L (LMT)
Entity type:Individual
Prefix:
First Name:CIELO
Middle Name:L
Last Name:BUSCH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:LYN
Other - Last Name:BUSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:70 OLD CANONCITO RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-9578
Mailing Address - Country:US
Mailing Address - Phone:505-231-6936
Mailing Address - Fax:
Practice Address - Street 1:826 CAMINO DE MONTE REY STE B2
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3961
Practice Address - Country:US
Practice Address - Phone:505-424-9527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-05
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6657225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist