Healthcare Provider Details

I. General information

NPI: 1134493232
Provider Name (Legal Business Name): PAIN MANAGEMENT AND SPECIAL CARE MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2012
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 MONTGOMERY BLVD NE SUITE E
ALBUQUERQUE NM
87109-1405
US

IV. Provider business mailing address

6800 MONTGOMERY BLVD NE SUITE E
ALBUQUERQUE NM
87109-1405
US

V. Phone/Fax

Practice location:
  • Phone: 505-883-9598
  • Fax: 505-883-4563
Mailing address:
  • Phone: 505-883-9598
  • Fax: 505-883-4563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number967
License Number StateNM

VIII. Authorized Official

Name: DR. TERESA IVONNE BELFON
Title or Position: PRESIDENT
Credential: DOM
Phone: 505-883-9598