Healthcare Provider Details

I. General information

NPI: 1295891257
Provider Name (Legal Business Name): JANET A LINDEN D.O.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 11/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 GEORGIA ST NE SUITE E-2
ALBUQUERQUE NM
87110-1388
US

IV. Provider business mailing address

3901 GEORGIA STREET NE SUITE E-2
ALBUQUERQUE NM
87110
US

V. Phone/Fax

Practice location:
  • Phone: 505-888-6400
  • Fax: 505-830-9256
Mailing address:
  • Phone: 505-888-6400
  • Fax: 505-830-9256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number575 RX1
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: