Healthcare Provider Details

I. General information

NPI: 1124031059
Provider Name (Legal Business Name): MAUREEN T ROBINS X DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 ALLENDALE ST
SANTA FE NM
87505-8803
US

IV. Provider business mailing address

823 ALLENDALE ST
SANTA FE NM
87505-8803
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-1774
  • Fax: 505-988-8960
Mailing address:
  • Phone: 505-988-1774
  • Fax: 505-988-8960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number657RX1
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: