Healthcare Provider Details

I. General information

NPI: 1124698691
Provider Name (Legal Business Name): ERIKA BITTNER DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 TRINITY DR STE B3
LOS ALAMOS NM
87544-2221
US

IV. Provider business mailing address

30 VERDE RIDGE ST APT A
LOS ALAMOS NM
87544-3243
US

V. Phone/Fax

Practice location:
  • Phone: 575-425-0805
  • Fax:
Mailing address:
  • Phone: 575-425-0805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberDOM1255
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: