Healthcare Provider Details

I. General information

NPI: 1295935336
Provider Name (Legal Business Name): CHRISTINA M ROGERS DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 SAN MATEO BLVD NE
ALBUQUERQUE NM
87110-6429
US

IV. Provider business mailing address

1403 SAN MATEO BLVD NE
ALBUQUERQUE NM
87110-6429
US

V. Phone/Fax

Practice location:
  • Phone: 505-228-1022
  • Fax:
Mailing address:
  • Phone: 505-228-1022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number643RX1
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: