Healthcare Provider Details

I. General information

NPI: 1720297468
Provider Name (Legal Business Name): ALDERETTE ACUPUNCTURE AND HERBAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 COOK AVE SUITE 210
RATON NM
87740-3959
US

IV. Provider business mailing address

210 COOK AVE SUITE 210
RATON NM
87740-3959
US

V. Phone/Fax

Practice location:
  • Phone: 505-445-1037
  • Fax: 505-445-1041
Mailing address:
  • Phone: 505-445-1037
  • Fax: 505-445-1041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number538
License Number StateNM

VIII. Authorized Official

Name: DANIEL NONE MAREZ
Title or Position: ACUPUNCTURIST
Credential: D.O.M.
Phone: 505-445-1037