Healthcare Provider Details

I. General information

NPI: 1669544243
Provider Name (Legal Business Name): MELISSA K STOCKTON D.O.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6208 MONTGOMERY BLVD NE SUITE F
ALBUQUERQUE NM
87109-1400
US

IV. Provider business mailing address

6208 MONTGOMERY BLVD NE SUITE F
ALBUQUERQUE NM
87109-1400
US

V. Phone/Fax

Practice location:
  • Phone: 505-888-6208
  • Fax: 505-888-3011
Mailing address:
  • Phone: 505-888-6208
  • Fax: 505-888-3011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number593
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: