Healthcare Provider Details

I. General information

NPI: 1508928532
Provider Name (Legal Business Name): JANE RAEL D.O.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19499 HWY 314
BELEN NM
87002
US

IV. Provider business mailing address

1512 RIO GRANDE BLVD SW
LOS LUNAS NM
87031-6130
US

V. Phone/Fax

Practice location:
  • Phone: 505-565-4325
  • Fax: 505-866-0639
Mailing address:
  • Phone: 505-565-4325
  • Fax: 505-866-0639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number603
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: