Healthcare Provider Details

I. General information

NPI: 1447430285
Provider Name (Legal Business Name): JACLYN M ODDI D.O.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2007
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12131 HWY 14 N
CEDAR CREST NM
87008-9461
US

IV. Provider business mailing address

12131 HWY 14 N
CEDAR CREST NM
87008-9461
US

V. Phone/Fax

Practice location:
  • Phone: 505-269-2599
  • Fax:
Mailing address:
  • Phone: 505-269-2599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number825
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: