Individual
THERESA MARIE CUSTODIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
2001 CENTRO FAMILIAR BLVD SW, ALBUQUERQUE, NM 87105-4592
(505) 873-7400
Mailing address
PO BOX 27561, ALBUQUERQUE, NM 87125-7561
(505) 873-7405
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
84185
NM
Other
Enumeration date
06/07/2025
Last updated
03/16/2026
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