Healthcare Provider Details

I. General information

NPI: 1215119615
Provider Name (Legal Business Name): MELISSA K STOCKTON, DOM, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6208 MONTGOMERY BLVD NE SUITE F
ALBUQUERQUE NM
87109-1400
US

IV. Provider business mailing address

6208 MONTGOMERY BLVD NE SUITE F
ALBUQUERQUE NM
87109-1400
US

V. Phone/Fax

Practice location:
  • Phone: 505-888-6208
  • Fax: 505-888-3011
Mailing address:
  • Phone: 505-888-6208
  • Fax: 505-888-3011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number593
License Number StateNM

VIII. Authorized Official

Name: DR. MELISSA K STOCKTON
Title or Position: PRESIDENT
Credential: D.O.M.
Phone: 505-888-6208