Healthcare Provider Details

I. General information

NPI: 1073784609
Provider Name (Legal Business Name): STEPHEN DANIEL SWART D.O.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2008
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 CAMINO DE MONTE REY SUITE B-2
SANTA FE NM
87505-3977
US

IV. Provider business mailing address

2735 LA BAJADA
SANTA FE NM
87505-5332
US

V. Phone/Fax

Practice location:
  • Phone: 505-424-9527
  • Fax:
Mailing address:
  • Phone: 505-424-9527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number248
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: