Healthcare Provider Details

I. General information

NPI: 1093095176
Provider Name (Legal Business Name): NORTH VALLEY ACUPUNCTURE AND FAMILY PRACTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 08/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 4TH ST NW STE. A
LOS RANCHOS NM
87107-6642
US

IV. Provider business mailing address

7120 4TH ST NW STE. A
LOS RANCHOS NM
87107-6642
US

V. Phone/Fax

Practice location:
  • Phone: 505-899-7095
  • Fax: 505-792-4085
Mailing address:
  • Phone: 505-899-7095
  • Fax: 505-792-4085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1050
License Number StateNM

VIII. Authorized Official

Name: RUTH MICHELLE MATKIN
Title or Position: DOCTOR OF ORIENTAL MEDICINE/OWNER
Credential: RN, DOM
Phone: 505-899-7095