Healthcare Provider Details

I. General information

NPI: 1215179262
Provider Name (Legal Business Name): SHAKTI HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N PASEO DE ONATE
ESPANOLA NM
87532-2619
US

IV. Provider business mailing address

415 N PASEO DE ONATE
ESPANOLA NM
87532-2619
US

V. Phone/Fax

Practice location:
  • Phone: 505-753-3369
  • Fax: 505-753-4006
Mailing address:
  • Phone: 505-753-3369
  • Fax: 505-753-4006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. JIWAN SHAKTI KHALSA
Title or Position: ACUPUNCTURIST
Credential: DOM
Phone: 505-753-3369