Healthcare Provider Details

I. General information

NPI: 1265860134
Provider Name (Legal Business Name): VIRPI JUMISKO D.O.M
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2013
Last Update Date: 10/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5520 WYOMING BLVD NE 210
ALBUQUERQUE NM
87109-3238
US

IV. Provider business mailing address

6217 ANTIGUA ST NE APT. A
ALBUQUERQUE NM
87111-7029
US

V. Phone/Fax

Practice location:
  • Phone: 505-358-1989
  • Fax:
Mailing address:
  • Phone: 516-978-3210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1113
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: