Healthcare Provider Details

I. General information

NPI: 1548681687
Provider Name (Legal Business Name): STEVEN MALINS DOM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2013
Last Update Date: 12/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7320 4TH ST NW
LOS RANCHOS NM
87107-6626
US

IV. Provider business mailing address

5901J WYOMING BLVD NE # 274
ALBUQUERQUE NM
87109-3866
US

V. Phone/Fax

Practice location:
  • Phone: 505-750-1238
  • Fax:
Mailing address:
  • Phone: 505-750-1238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1120
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: