Healthcare Provider Details

I. General information

NPI: 1760784409
Provider Name (Legal Business Name): DESERT HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2010
Last Update Date: 12/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 COMANCHE RD NE SUITE A3
ALBUQUERQUE NM
87107-4546
US

IV. Provider business mailing address

3500 COMANCHE RD NE SUITE A3
ALBUQUERQUE NM
87107-4546
US

V. Phone/Fax

Practice location:
  • Phone: 505-205-8941
  • Fax:
Mailing address:
  • Phone: 505-205-8941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: ABBEY L THEROUX
Title or Position: DOCTOR OF ORIENTAL MEDICINE
Credential: DOM
Phone: 505-205-8941