Healthcare Provider Details

I. General information

NPI: 1336724079
Provider Name (Legal Business Name): LOS ALAMOS ACUPUNCTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 TRINITY DR STE Q
LOS ALAMOS NM
87544-4103
US

IV. Provider business mailing address

1599 39TH ST APT B
LOS ALAMOS NM
87544-2899
US

V. Phone/Fax

Practice location:
  • Phone: 505-396-4030
  • Fax:
Mailing address:
  • Phone: 802-373-2352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. NIKHIL RAMBURN
Title or Position: OWNER
Credential: DOM
Phone: 802-373-2352