Healthcare Provider Details

I. General information

NPI: 1780797688
Provider Name (Legal Business Name): ALICE K LAYBOURNE D.O.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10900 MENAUL BLVD NE SUITE F
ALBUQUERQUE NM
87112-2455
US

IV. Provider business mailing address

7824 NORTHRIDGE AVE NE
ALBUQUERQUE NM
87109-3014
US

V. Phone/Fax

Practice location:
  • Phone: 505-270-5158
  • Fax: 505-298-7244
Mailing address:
  • Phone: 505-332-7236
  • Fax: 505-298-7244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number616
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: