Healthcare Provider Details

I. General information

NPI: 1861652877
Provider Name (Legal Business Name): CENTER FOR HOLISTIC HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 EUBANK BLVD. NE SUITE H
ALBUQUERQUE NM
87112-2878
US

IV. Provider business mailing address

PO BOX 14695
ALBUQUERQUE NM
87191-4695
US

V. Phone/Fax

Practice location:
  • Phone: 505-298-7371
  • Fax: 505-298-7326
Mailing address:
  • Phone: 505-298-7371
  • Fax: 505-298-7326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number161RX1
License Number StateNM

VIII. Authorized Official

Name: DR. DIANE H. POLASKY
Title or Position: OWNER
Credential: DOM
Phone: 505-298-7371