Healthcare Provider Details

I. General information

NPI: 1558536946
Provider Name (Legal Business Name): HIGH DESERT HOLISTIC HEALTH CARE & PAIN MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 10TH ST
ALAMOGORDO NM
88310-6423
US

IV. Provider business mailing address

911 10TH ST
ALAMOGORDO NM
88310-6423
US

V. Phone/Fax

Practice location:
  • Phone: 575-437-3270
  • Fax: 575-437-3371
Mailing address:
  • Phone: 575-437-3270
  • Fax: 575-437-3371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number0009
License Number StateNM

VIII. Authorized Official

Name: DR. MARY R PALUSZEK-PIRC
Title or Position: OWNER
Credential: D.N.,M.P.H
Phone: 575-437-3270