Healthcare Provider Details

I. General information

NPI: 1689907388
Provider Name (Legal Business Name): AMRITA ACUPUNCTURE & HERBOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2009
Last Update Date: 09/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 N 4TH ST
BELEN NM
87002-4315
US

IV. Provider business mailing address

219 N 4TH ST
BELEN NM
87002-4315
US

V. Phone/Fax

Practice location:
  • Phone: 505-861-0332
  • Fax: 505-861-0332
Mailing address:
  • Phone: 505-861-0332
  • Fax: 505-861-0332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number497RX2
License Number StateNM

VIII. Authorized Official

Name: SUZANNE L BARRY
Title or Position: OWNER
Credential: DOM
Phone: 505-861-0332