Healthcare Provider Details

I. General information

NPI: 1093217788
Provider Name (Legal Business Name): NAYELI D NAVARRO DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
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

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

V. Phone/Fax

Practice location:
  • Phone: 505-429-4960
  • Fax: 949-864-3135
Mailing address:
  • Phone: 505-429-4960
  • Fax: 949-864-3135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1188
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: