Healthcare Provider Details

I. General information

NPI: 1699524272
Provider Name (Legal Business Name): DESERT SKY OSTEOPATHY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2024
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 PRINCETON DR SE
ALBUQUERQUE NM
87106-3019
US

IV. Provider business mailing address

1208 PRINCETON DR SE
ALBUQUERQUE NM
87106-3019
US

V. Phone/Fax

Practice location:
  • Phone: 505-346-7656
  • Fax:
Mailing address:
  • Phone: 505-346-7656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State

VIII. Authorized Official

Name: MEGAN SUSANNE SOFKA
Title or Position: OWNER
Credential: DO
Phone: 505-346-7656