Healthcare Provider Details

I. General information

NPI: 1932507829
Provider Name (Legal Business Name): TERESA URREA-MUNZ DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11000 SPAIN RD NE BUILDING E
ALBUQUERQUE NM
87111-1883
US

IV. Provider business mailing address

4625 SHERWOOD ST NE
ALBUQUERQUE NM
87109-2817
US

V. Phone/Fax

Practice location:
  • Phone: 505-604-4246
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1148
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: