Healthcare Provider Details

I. General information

NPI: 1154816007
Provider Name (Legal Business Name): DESERT OASIS ACUPUNCTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2018
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 CENTRAL AVE SW STE E
ALBUQUERQUE NM
87104-1183
US

IV. Provider business mailing address

1700 CENTRAL AVE SW STE E
ALBUQUERQUE NM
87104-1183
US

V. Phone/Fax

Practice location:
  • Phone: 505-219-4310
  • Fax: 505-219-4296
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1228
License Number StateNM

VIII. Authorized Official

Name: JOSHUA BLANKMAN
Title or Position: OWNER
Credential:
Phone: 505-507-9793