Healthcare Provider Details

I. General information

NPI: 1710216767
Provider Name (Legal Business Name): JESSICA R SCHULTE DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2009
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 HOMESTEADS RD STE F
PLACITAS NM
87043-9229
US

IV. Provider business mailing address

905 COUNTRY CLUB DR. SE APT K
RIO RANCHO NM
87124
US

V. Phone/Fax

Practice location:
  • Phone: 505-401-7738
  • Fax:
Mailing address:
  • Phone: 505-471-5006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberDOM1129
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: