Healthcare Provider Details

I. General information

NPI: 1427831296
Provider Name (Legal Business Name): DULCE CERVANTES MONTALVO LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 08/18/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY OF NM MSC09-3870
ABQ NM
87131
US

IV. Provider business mailing address

1349 ARCADIAN TRL NW
ALBUQUERQUE NM
87107-3404
US

V. Phone/Fax

Practice location:
  • Phone: 505-277-3136
  • Fax:
Mailing address:
  • Phone: 505-415-1777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT9697
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: