Healthcare Provider Details

I. General information

NPI: 1023416468
Provider Name (Legal Business Name): WESTSIDE FAMILY ACUPUNCTURE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2014
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 COORS BLVD NW STE E
ALBUQUERQUE NM
87120-1926
US

IV. Provider business mailing address

5115 COORS BLVD NW STE E
ALBUQUERQUE NM
87120-1926
US

V. Phone/Fax

Practice location:
  • Phone: 505-897-6560
  • Fax: 505-715-5537
Mailing address:
  • Phone: 505-897-6560
  • Fax: 505-715-5537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: PAUL D DUMONT
Title or Position: PRESIDENT
Credential: DIPL. OM. DOM
Phone: 505-897-6560