Healthcare Provider Details

I. General information

NPI: 1861890253
Provider Name (Legal Business Name): GEOFFREY HAYES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2014
Last Update Date: 12/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 SAN PEDRO DR NE SUITE B2
ALBUQUERQUE NM
87110-3334
US

IV. Provider business mailing address

2730 SAN PEDRO DR NE SUITE B2
ALBUQUERQUE NM
87110-3334
US

V. Phone/Fax

Practice location:
  • Phone: 505-433-2054
  • Fax:
Mailing address:
  • Phone: 505-433-2054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1161
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: