Healthcare Provider Details

I. General information

NPI: 1093858961
Provider Name (Legal Business Name): KAZUHIKO WATASE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 WASHINGTON ST SE STE I
ALBUQUERQUE NM
87108-2713
US

IV. Provider business mailing address

457 WASHINGTON ST SE STE I
ALBUQUERQUE NM
87108-2713
US

V. Phone/Fax

Practice location:
  • Phone: 505-266-1752
  • Fax: 505-262-1213
Mailing address:
  • Phone: 505-266-1752
  • Fax: 505-262-1213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number344
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: