Healthcare Provider Details

I. General information

NPI: 1831141266
Provider Name (Legal Business Name): STEPHEN ALEXANDER LAJOIE D.O.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12165 HWY 14 N SUITE B-7
CEDAR CREST NM
87008-9537
US

IV. Provider business mailing address

5 AMANDA CT
TIJERAS NM
87059-7825
US

V. Phone/Fax

Practice location:
  • Phone: 505-281-8446
  • Fax: 505-281-3099
Mailing address:
  • Phone: 505-573-0300
  • Fax: 505-281-3099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number640
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: