Healthcare Provider Details

I. General information

NPI: 1245565381
Provider Name (Legal Business Name): FERAL A MACLOUD DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2009
Last Update Date: 10/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 COUNTY ROAD 122
ESPANOLA NM
87532-3187
US

IV. Provider business mailing address

518 OLD SANTA FE TRL #171
SANTA FE NM
87505-0398
US

V. Phone/Fax

Practice location:
  • Phone: 505-753-7576
  • Fax:
Mailing address:
  • Phone: 505-204-1239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number502
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: