Healthcare Provider Details

I. General information

NPI: 1801332325
Provider Name (Legal Business Name): RED ROOT ACUPUNCTURE & HERBS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2017
Last Update Date: 09/30/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 RIO GRANDE BLVD NW STE E
ALBUQUERQUE NM
87104-3240
US

IV. Provider business mailing address

2400 RIO GRANDE BLVD NW STE E
ALBUQUERQUE NM
87104-3240
US

V. Phone/Fax

Practice location:
  • Phone: 505-242-2032
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1134
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1126
License Number StateNM

VIII. Authorized Official

Name: MISS MONICA NICOLE LUCERO
Title or Position: OWNERACUPUNCTURIST
Credential: DOM
Phone: 505-550-5358