Healthcare Provider Details

I. General information

NPI: 1740302447
Provider Name (Legal Business Name): SUZANNE L BARRY D.O.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/08/2007
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: 505-861-1753
Mailing address:
  • Phone: 505-861-0332
  • Fax: 505-861-1753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number497
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: