Healthcare Provider Details

I. General information

NPI: 1861138620
Provider Name (Legal Business Name): RIO RANCHO ACUPUNCTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 ACADEMY RD NE STE 210
ALBUQUERQUE NM
87111-7370
US

IV. Provider business mailing address

10400 ACADEMY RD NE STE 210
ALBUQUERQUE NM
87111-7370
US

V. Phone/Fax

Practice location:
  • Phone: 505-355-1984
  • Fax:
Mailing address:
  • Phone: 505-355-1984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ANDREA BROGDON
Title or Position: OWNER
Credential: DOM
Phone: 970-222-0575