Healthcare Provider Details

I. General information

NPI: 1376731091
Provider Name (Legal Business Name): OPTIONS ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 SIERRA VISTA CT NE SUITE C
ALBUQUERQUE NM
87111-3422
US

IV. Provider business mailing address

4816 GOODRICH AVE NE
ALBUQUERQUE NM
87110-1139
US

V. Phone/Fax

Practice location:
  • Phone: 505-918-7596
  • Fax:
Mailing address:
  • Phone: 505-918-7596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number857
License Number StateNM

VIII. Authorized Official

Name: DR. BRENDA KAY PETTY
Title or Position: DOCTOR OF ORIENTAL MEDICINE
Credential:
Phone: 505-918-7596