Healthcare Provider Details

I. General information

NPI: 1306033873
Provider Name (Legal Business Name): JOY CAO DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 WASHINGTON ST NE
ALBUQUERQUE NM
87108
US

IV. Provider business mailing address

533 WASHINGTON ST NE
ALBUQUERQUE NM
87108
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-2090
  • Fax: 505-262-0808
Mailing address:
  • Phone: 505-262-2090
  • Fax: 505-262-0808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number249
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: