Healthcare Provider Details

I. General information

NPI: 1063423952
Provider Name (Legal Business Name): DAVID JOSEPH CANZONE D.O.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2074 GALISTEO ST UNIT A2
SANTA FE NM
87505-2138
US

IV. Provider business mailing address

1850 OTOWI RD
SANTA FE NM
87505
US

V. Phone/Fax

Practice location:
  • Phone: 505-989-7418
  • Fax: 505-986-8874
Mailing address:
  • Phone: 505-986-9772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number195RX1
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: