Healthcare Provider Details

I. General information

NPI: 1730259045
Provider Name (Legal Business Name): BIRGIT NONE MCGAUGHEY DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 75 BOX 1224 447 STATE ROAD 95
LOS OJOS NM
87551-9723
US

IV. Provider business mailing address

HC 75 BOX 1224 447 STATE ROAD 95
LOS OJOS NM
87551-9723
US

V. Phone/Fax

Practice location:
  • Phone: 505-588-0264
  • Fax: 505-588-0008
Mailing address:
  • Phone: 505-588-0264
  • Fax: 505-588-0008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number761
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: