Healthcare Provider Details

I. General information

NPI: 1720313794
Provider Name (Legal Business Name): VALENCIA ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2009
Last Update Date: 10/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 EUBANK BLVD NE
ALBUQUERQUE NM
87112-5310
US

IV. Provider business mailing address

1012 EUBANK BLVD NE
ALBUQUERQUE NM
87112-5310
US

V. Phone/Fax

Practice location:
  • Phone: 505-462-2970
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number700
License Number StateNM

VIII. Authorized Official

Name: BONNIE GAYLE PACIELLO
Title or Position: DOCTOR OF ORIENTAL MEDICINE
Credential: DOM
Phone: 505-462-2970