Healthcare Provider Details

I. General information

NPI: 1659605368
Provider Name (Legal Business Name): PUBLIC HEALTH ACUPUNCTURE OF NEW MEXICO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2009
Last Update Date: 09/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 PRINCETON DR NE
ALBUQUERQUE NM
87106-2618
US

IV. Provider business mailing address

PO BOX 35863
ALBUQUERQUE NM
87176-5863
US

V. Phone/Fax

Practice location:
  • Phone: 505-232-7654
  • Fax:
Mailing address:
  • Phone: 505-232-7654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberVARIOUS
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number608
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberVARIOUS
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberVARIOUS
License Number StateNM

VIII. Authorized Official

Name: NITYAMO LIAN
Title or Position: PRESIDENT
Credential: DOM, MPH
Phone: 505-232-7654