Healthcare Provider Details

I. General information

NPI: 1740277953
Provider Name (Legal Business Name): VALERIE ECKLUND TALENTO DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNE VALERIE ECKLUND DOM

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711-A ENCINO PL NE
ALBUQUERQUE NM
87102-2652
US

IV. Provider business mailing address

711-A ENCINO PL NE
ALBUQUERQUE NM
87102-2652
US

V. Phone/Fax

Practice location:
  • Phone: 505-243-8058
  • Fax: 505-243-8057
Mailing address:
  • Phone: 505-243-8058
  • Fax: 505-243-8057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number82
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: