Provider Demographics
NPI:1215757521
Name:TENEBROSO CRISENCIO TAMBIEN, XXX (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:XXX
Middle Name:
Last Name:TENEBROSO CRISENCIO TAMBIEN
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:CRISENCIO
Other - Middle Name:
Other - Last Name:TENEBROSO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:36 WILKERSON STREET
Mailing Address - Street 2:
Mailing Address - City:THOROLD
Mailing Address - State:ZZ - FOREIGN COUNTRIES
Mailing Address - Zip Code:L2V0G4
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BUFFALO PSYCHIATRIC CENTER
Practice Address - Street 2:400 FOREST AVENUE
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213
Practice Address - Country:US
Practice Address - Phone:716-816-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY75917801163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult