Healthcare Provider Details

I. General information

NPI: 1467627448
Provider Name (Legal Business Name): ROLANDO C HALL D.O.M. L.A.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7920 WYOMING BLVD NE SUITE B
ALBUQUERQUE NM
87109-6020
US

IV. Provider business mailing address

2505 MILAGRO RIDGE CT NE
RIO RANCHO NM
87124-2574
US

V. Phone/Fax

Practice location:
  • Phone: 505-821-6300
  • Fax:
Mailing address:
  • Phone: 505-702-9911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number961
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: