Healthcare Provider Details

I. General information

NPI: 1255667549
Provider Name (Legal Business Name): SANDIA MOUNTAIN ACUPUNCTURE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2009
Last Update Date: 10/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 COMANCHE RD NE BUILDING E, SUITE 13
ALBUQUERQUE NM
87107-4546
US

IV. Provider business mailing address

7217 YORKTOWN AVE NE
ALBUQUERQUE NM
87109-5046
US

V. Phone/Fax

Practice location:
  • Phone: 505-702-7675
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1008
License Number StateNM

VIII. Authorized Official

Name: MATTHEW G. KREITZER
Title or Position: OWNER
Credential:
Phone: 505-702-7675