Healthcare Provider Details

I. General information

NPI: 1871063347
Provider Name (Legal Business Name): DENISE LENGYEL DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7528 4TH ST NW STE A
LOS RANCHOS NM
87107-6683
US

IV. Provider business mailing address

804 CAMINO DEL PRADO NW
ALBUQUERQUE NM
87114-1050
US

V. Phone/Fax

Practice location:
  • Phone: 585-506-6869
  • Fax:
Mailing address:
  • Phone: 585-506-6869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1212
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: