MEDICARE: VALENCIA ACUPUNCTURE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	700	NM

General Provider Information

NPI Number	:	1720313794
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALENCIA ACUPUNCTURE

Provider Business Mailing Address
First Line	:	1012 EUBANK BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-5310
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1012 EUBANK BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-5310
Country	:	US
Telephone Number	:	505-462-2970
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR OF ORIENTAL MEDICINE
Name	:	BONNIE GAYLE PACIELLO
Credential	:	DOM
Telephone Number	:	505-462-2970

Provider Enumeration Date	:	10/08/2009
Last Update Date	:	10/08/2009

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