Healthcare Provider Details

I. General information

NPI: 1396149100
Provider Name (Legal Business Name): BALANCED HEALTH ACUPUNCTURE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2014
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 SANTA ANA ST
LAS VEGAS NM
87701-3758
US

IV. Provider business mailing address

PO BOX 2183
LAS VEGAS NM
87701-2183
US

V. Phone/Fax

Practice location:
  • Phone: 505-454-0003
  • Fax: 505-910-4665
Mailing address:
  • Phone: 505-454-0003
  • Fax: 505-910-4665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. BERNADETTE J LUJAN
Title or Position: PROVIDER/OWNER
Credential: DOM, LAC
Phone: 505-454-0003