Healthcare Provider Details

I. General information

NPI: 1194785253
Provider Name (Legal Business Name): SOPHIA CHRISTINE SWENSEN DOM, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: E. SOPHIA CHRISTINE TREZZA DOM, LMT

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6915 CALLE ALMERIA NE 1620 INDIAN SCHOOL ROAD NE
ALBUQUERQUE NM
87113-1093
US

IV. Provider business mailing address

6915 CALLE ALMERIA NE
ALBUQUERQUE NM
87113-1093
US

V. Phone/Fax

Practice location:
  • Phone: 505-345-9934
  • Fax:
Mailing address:
  • Phone: 505-345-3708
  • Fax: 505-344-9620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number773
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: