Healthcare Provider Details

I. General information

NPI: 1033380399
Provider Name (Legal Business Name): BRICE M HARVEY D.O.M
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 MENAUL BLVD NE
ALBUQUERQUE NM
87110-2871
US

IV. Provider business mailing address

17 AMBER LN
TIJERAS NM
87059-7489
US

V. Phone/Fax

Practice location:
  • Phone: 505-480-0779
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number925
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: