Healthcare Provider Details

I. General information

NPI: 1578724282
Provider Name (Legal Business Name): AUBREY RAGLAND, D.O.M., L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7510 MONTGOMERY BLVD NE SUITE 206
ALBUQUERQUE NM
87109-1500
US

IV. Provider business mailing address

7510 MONTGOMERY BLVD NE SUITE 206
ALBUQUERQUE NM
87109-1500
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-1701
  • Fax: 505-884-1785
Mailing address:
  • Phone: 505-884-1701
  • Fax: 505-884-1785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number687
License Number StateNM

VIII. Authorized Official

Name: AUBREY EARL RAGLAND
Title or Position: OWNER
Credential: D.O.M.
Phone: 505-884-1701