Healthcare Provider Details

I. General information

NPI: 1023267002
Provider Name (Legal Business Name): RED PHOENIX ACUPUNCTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2008
Last Update Date: 09/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4041 BARBARA LOOP SE SUITE A
RIO RANCHO NM
87124-1065
US

IV. Provider business mailing address

4041 BARBARA LOOP SE SUITE A
RIO RANCHO NM
87124-1065
US

V. Phone/Fax

Practice location:
  • Phone: 505-896-6965
  • Fax:
Mailing address:
  • Phone: 505-896-6965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number906
License Number StateNM

VIII. Authorized Official

Name: AMY BONNETT
Title or Position: OWNER
Credential: DOM
Phone: 505-896-6965