Healthcare Provider Details

I. General information

NPI: 1336102748
Provider Name (Legal Business Name): SHARON LYNN BAMBERG L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 10/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10324 DURHAM ST NW
ALBUQUERQUE NM
87114-5541
US

IV. Provider business mailing address

10324 DURHAM ST NW
ALBUQUERQUE NM
87114-5541
US

V. Phone/Fax

Practice location:
  • Phone: 505-301-3207
  • Fax: 505-899-1200
Mailing address:
  • Phone: 505-301-3207
  • Fax: 505-899-1200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1139
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: