Healthcare Provider Details

I. General information

NPI: 1134399314
Provider Name (Legal Business Name): CHINESE NATURAL HEALING CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1517 EUBANK BLVD NE
ALBUQUERQUE NM
87112-4112
US

IV. Provider business mailing address

1517 EUBANK BLVD NE
ALBUQUERQUE NM
87112-4112
US

V. Phone/Fax

Practice location:
  • Phone: 505-294-7368
  • Fax: 505-294-7424
Mailing address:
  • Phone: 505-294-7368
  • Fax: 505-294-7424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number267
License Number StateNM

VIII. Authorized Official

Name: DR. XIAORONG LINDA LI
Title or Position: OWNER
Credential: DOM
Phone: 505-294-7368