Healthcare Provider Details

I. General information

NPI: 1508342593
Provider Name (Legal Business Name): ACUPUNTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 07/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COUNTRY ROAD BO11 #26
HOLMAN NM
87723
US

IV. Provider business mailing address

2003 HOPI RD
SANTA FE NM
87505-2401
US

V. Phone/Fax

Practice location:
  • Phone: 505-603-4344
  • Fax:
Mailing address:
  • Phone: 505-603-4344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1174
License Number StateNM

VIII. Authorized Official

Name: DR. RENE ASHTARA
Title or Position: DOCTOR OF ORIENTAL MEDICINE
Credential: DOM
Phone: 505-603-4344