Healthcare Provider Details

I. General information

NPI: 1053615500
Provider Name (Legal Business Name): BARRI J LESTER D.O.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2010
Last Update Date: 12/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 5TH ST STE 12
SANTA FE NM
87505-3480
US

IV. Provider business mailing address

PO BOX 5676
SANTA FE NM
87502-5676
US

V. Phone/Fax

Practice location:
  • Phone: 505-231-8065
  • Fax:
Mailing address:
  • Phone: 505-231-8065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1043
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: